title: Open access endoscopy in rural and remote Western Australia: does it work?
abstract: BACKGROUND
  Access to diagnostic endoscopy is limited in rural and remote Western Australia. Published reports suggest open access referrals may result in over-servicing, this is reduced by adherence to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. The aim was to assess whether an outreach surgical service offering open access endoscopy to rural areas was being over utilized.
  
  
  METHODS
  Prospective data collection from all patients undergoing upper and lower endoscopy procedures between January 1996 and June 2000 were included in the present study. Indications for referral between the general practitioners and the visiting surgeons were reviewed in patient records and assessed for compliance with the ASGE guidelines. The groups were analysed for appropriateness of referrals and frequency of positive pathology investigations. Records for all patients undergoing colonoscopy were reviewed to determine the reason and number of cancelled procedures.
  
  
  RESULTS
  A total of 772 endoscopies were performed and 75% were booked as open access services. The referral rate for procedures was greater for general practitioners (583) compared to the visiting surgeons (189), the overall compliance rate for approved indications using the ASGE guidelines for both groups was 92%. There was no significant difference in pathology found between groups.
  
  
  CONCLUSIONS
  The present study shows that an outreach rural surgical service programme in Western Australia offering open access endoscopy conforms to international guidelines and does not induce unnecessary procedures. Rural patients benefit from a personal cost savings and convenience. There is an associated reduction in government-assisted travel costs to larger centres as well as decreased waiting lists.
authors.affiliation: Rural Surgical Service, University of Western Australia Department of Surgery, Nedlands, Western Australia, Australia.
authors.forename: Wayne
authors.initials: W
authors.lastname: Hughes-Anderson
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Rankin
authors.forename: Jill
authors.initials: J
authors.lastname: House
authors.forename: James
authors.initials: J
authors.lastname: Aitken
authors.forename: Dugal
authors.initials: D
authors.lastname: Heath
authors.forename: Anthony K
authors.initials: AK
authors.lastname: House
mesh_terms: D003113:Colonoscopy; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005194:Family Practice; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006801:Humans; D008507:Medically Underserved Area; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D014904:Western Australia