A Comparison of Hospital and Nonhospital Colonoscopy: Wait Times, Fees and Guideline Adherence to Follow‐Up Interval

Ivers, Noah; Schwandt, Michael; Hum, Susan; Martin, D A; Tinmouth, Jill; Pimlott, Nicholas

doi:10.1155/2011/514656

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…A recent survey involving 956 patients (14) found that wait times at out-of-hospital clinics were shorter than at in-hospital facilities for asymptomatic patients awaiting screening colonoscopy, but not for symptomatic patients. This strategy of using out-of-hospital facilities may be particularly useful for screening colonoscopy, which accounted for 20% of indications in the 2012 survey.…”

Section: Discussionmentioning

confidence: 99%

The 2012 Sage Wait Times Program: Survey of Access to Gastroenterology in Canada

Leddin

Armstrong

Borgaonkar

et al. 2013

Canadian Journal of Gastroenterology

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Section: Discussionmentioning

confidence: 99%

The 2012 Sage Wait Times Program: Survey of Access to Gastroenterology in Canada

Leddin

Armstrong

Borgaonkar

et al. 2013

Canadian Journal of Gastroenterology

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“…Further, many of these private clinics are likely located in urban areas, leaving more rural and remote areas relatively underserved. Additional research is needed to better understand the impact of private clinics on colonoscopy utilisation and outcomes considering the concerns around quality of colonoscopies performed in private clinics, and the barriers that individuals may face in accessing private clinics given the extra fees often charged to patients at these clinics 15–17 33 34…”

Section: Discussionmentioning

confidence: 99%

Regional variations and associations between colonoscopy resource availability and colonoscopy utilisation: a population-based descriptive study in Ontario, Canada

Webber

Flemming

Birtwhistle

et al. 2022

BMJ Open Gastroenterol

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ObjectiveThere is substantial variation in colonoscopy use and evidence of long wait times for the procedure. Understanding the role of system-level resources in colonoscopy utilisation may point to a potential intervention target to improve colonoscopy use. This study characterises colonoscopy resource availability in Ontario, Canada and evaluates its relationship with colonoscopy utilisation.DesignWe conducted a population-based study using administrative health data to describe regional variation in colonoscopy availability for Ontario residents (age 18–99) in 2013. We identified 43 colonoscopy networks in the province in which we described variations across three colonoscopy availability measures: colonoscopist density, private clinic access and distance to colonoscopy. We evaluated associations between colonoscopy resource availability and colonoscopy utilisation rates using Pearson correlation and log binomial regression, adjusting for age and sex.ResultsThere were 9.4 full-time equivalent colonoscopists per 100 000 Ontario residents (range across 43 networks 0.0 to 21.8); 29.5% of colonoscopies performed in the province were done in private clinics (range 1.2%–55.9%). The median distance to colonoscopy was 3.7 km, with 5.9% travelling at least 50 km. Lower colonoscopist density was correlated with lower colonoscopy utilisation rates (r=0.53, p<0.001). Colonoscopy utilisation rates were 4% lower in individuals travelling 50 to <200 km and 11% lower in individuals travelling ≥200 km to colonoscopy, compared to <10 km. There was no association between private clinic access and colonoscopy utilisation.ConclusionThe substantial variations in colonoscopy resource availability and the relationship demonstrated between colonoscopy resource availability and use provides impetus for health service planners and decision-makers to address these potential inequalities in access in order to support the use of this medically necessary procedure.

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“…It has been suggested that the use of IHFs to provide patients with endoscopy is an option to decrease patient wait times by offsetting the workload of hospital-based endoscopic practices. In 2011, Ivers et al reported shorter wait times for screening colonoscopies, but not for symptomatic patients, at nonhospital clinics compared to hospital settings [ 15 ]. This IHF has demonstrated that wait times for patients presenting with symptoms, abnormal test results, and physical examination findings suspicious for GI malignancy undergo diagnostic endoscopy well within the CCO recommendations.…”

Section: Discussionmentioning

confidence: 99%

Independent Heath Facility Meets Cancer Care Ontario and Canadian Association of Gastroenterology Guidelines for Endoscopic Procedure Wait Times While Meeting Quality Indicators: A Retrospective Review

Kegel

Sne

Rice

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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Background Canadian independent health facilities (IHFs) have been implemented to reduce hospital endoscopy volume and expedite endoscopic evaluations for patients suspected to have underlying colorectal cancer. Methods We conducted a retrospective review of a prospective database at a large-volume urban IHF. The primary outcomes were wait times, and the secondary outcomes were colonoscopy quality indicators and complication rates. Results Median wait times from referral to colonoscopy met the recommendations set out by the Canadian Association of Gastroenterology and Cancer Care Ontario for all indications: chronic abdominal pain: 43 days; new onset change in bowel habits: 36 days; bright red rectal bleeding: 42 days; documented iron-deficiency anemia: 43 days; fecal occult blood test positive: 38 days; cancer likely based on imaging or physical exam: 23 days; chronic diarrhea and chronic constipation: 42 days; and screening colonoscopies: 55 days. Secondary outcomes of quality indicators and complication rates all met or exceeded the CCO and CAG recommendations. Conclusions This IHF met the recommended wait times for all indications for colonoscopy while maintaining high procedural quality and safety. IHFs are one solution to help meet the increasing demand for colonoscopy in Ontario.

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A Comparison of Hospital and Nonhospital Colonoscopy: Wait Times, Fees and Guideline Adherence to Follow‐Up Interval

Abstract: Nonhospital clinics were far less likely to adhere to guidelines regarding follow-up intervals for low-risk patients. Given the implications for both health care costs and patient safety, further study is needed to determine the cause of this disparity.

Cited by 4 publications

References 17 publications

The 2012 Sage Wait Times Program: Survey of Access to Gastroenterology in Canada

The 2012 Sage Wait Times Program: Survey of Access to Gastroenterology in Canada

Regional variations and associations between colonoscopy resource availability and colonoscopy utilisation: a population-based descriptive study in Ontario, Canada

Independent Heath Facility Meets Cancer Care Ontario and Canadian Association of Gastroenterology Guidelines for Endoscopic Procedure Wait Times While Meeting Quality Indicators: A Retrospective Review

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