Can we improve the uptake of gastroscopy in the population at risk for gastric cancer? The effect of home letter information.
The poor outlook for gastric cancer in Britain is largely due to late diagnosis. Earlier diagnosis will require both easy access to endoscopy and increased public awareness of dyspeptic symptoms. We used information by personal letter to encourage reporting of potentially significant symptoms in patients over 40 years of age. The aim of this study was to measure the acceptability and effect on gastroscopy rates of home letter information. Patients over 40 registered with 12 general practices were used in the study (practice population 80,000). Patients over 40 from another nine practices (practice population 46,500) acted as controls. A letter encouraging consultation for new dyspeptic symptoms was sent to all study subjects. Gastroscopy rates were compared in both study and control populations. Questionnaires on symptoms were sent to 500 study subjects. The principal outcome measure was the gastroscopy rate in people over 40 in both populations, before and during the intervention. The gastroscopy rate was 23% higher in the study than in the control population during the study (3.32 vs. 2.7%, P = 0.00016, chi 2 = 14.25). Gastroscopy uptake increased by 85% from 1991/2 to 1993/4 in the study group and by 34% in the control group (chi 2 = 14.02, P = 0.00018). Thirty-one per cent of questionnaire respondents had dyspeptic symptoms; only 3% had 'significant' symptoms of between 2 and 52 weeks duration. Home letters are an acceptable and efficient method of increasing gastroscopy uptake in dyspeptic patients over 40.
McCulloch
P
P
Department of Surgery, University of Liverpool, UK.
Williams
E
E
McCulloch
C
C
Mullins
D
D
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004415:Dyspepsia / Q000209:etiology; D005773:Gastroscopy / Q000706:statistics & numerical data*; D006266:Health Education; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D013274:Stomach Neoplasms / Q000175:diagnosis*; D011795:Surveys and Questionnaires