OPEN ACCESS UPPER GASTROINTESTINAL ENDOSCOPY: FINANCIAL BURDEN OR BENEFIT FOR HOSPITALS?

OBJECTIVES: To assess the efficiency of an open access upper gastrointestinal endoscopy (Oesophagogastroduodenoscopy, OGD) service at Taranaki base Hospital, New Zealand by comparing the diagnostic yield of referrals made by hospital-based consultants with those fromgeneral practitioners (GPs) to see if GPs were referring more patients with normal examination. METHODS: For 12 consecutive months, from the 1st of Dec 2013, data was collected prospectively for all diagnostic OGD’s done at Taranaki Base Hospital. Analysis of the number of normal OGD’s and the diagnostic yield of abnormal findings from each source of referral (consultant vs GPs) was done using the chi square test. RESULTS: Out of 829 diagnostic OGD’s, 499 (60.2%) were referred by hospital-based consultants from all specialities and 330 (39.8%) by GPs. Anaemia and/or Upper GI bleeding (n=280/829; 33.8%) and dyspepsia (n=254/829; 30.6%) were the common indications for OGD referrals. Overall 292/829(35.2%) OGDs were normal. OGDs were normal in 91/330 (27.6%) GP-referrals and 201/499 (40.3%) consultant-referrals (p 0.05). Gastroesophageal reflux disease was the commonest finding on OGD in 151/330 (45.8%) GP-referrals and 154/499 (30.9%) consultant- referrals. Malignancy was detected in 4/330 (1.2%) GP-referralsand 13 (2.6%) consultant-referrals (p=0.16). CONCLUSION: We did not find a higher rate of normal OGD’s inpatients referred to Taranaki Base Hospital by the GPs, which goes against the usual assumption that open access upper gastrointestinal endoscopy service (utilized by GPs) is a financial burden on a public funded health system. We think it is an effective way of managing most dyspeptic patients in community.