title: Randomized clinical trial comparing consultant-led or open access investigation for large bowel symptoms.
abstract: BACKGROUND
  Referral of patients with large bowel symptoms is common and increasing. Currently most of these referrals are assessed at an outpatient clinic to determine the need and priority for investigation.
  
  
  METHODS
  Over 21 months, 1131 patients referred by the general practitioner with large bowel symptoms were randomized. Patients in the consultant-led group were assessed by surgeons with a colorectal interest while those in the open access group underwent colonoscopy if they were 55 years or older and flexible sigmoidoscopy if younger.
  
  
  RESULTS
  The most common symptom among referred patients was rectal bleeding (69.1 per cent) followed by change in bowel habit (48.8 per cent) and abdominal pain (32.3 per cent). There was a significant trend (P < 0.001) for patients in the consultant-led to have more investigations, and more patients in this group had no investigations (P < 0.001). Despite this, the percentage of patients with colonic or other pathology diagnosed was the same in both groups, 63.6 per cent in the consultant-led group compared with 61.8 per cent in the open access group (P = 0.558). Likewise the percentage of patients with cancer or other significant pathology was similar in both groups (13.9 versus 15.4 per cent; P = 0.532). The mean(s.d.) time to diagnose cancer or other significant pathology was 55.1(39.2) days in the consultant-led group compared with 57.4(33.6) days in the open access group (P = 0.514). The cost per patient was almost pound 105 more for patients in the consultant-led group.
  
  
  CONCLUSIONS
  Patients referred by the general practitioner with large bowel symptoms should go directly to a properly managed and staffed open access large bowel investigation unit. This would enable most patients to have their investigations completed at one hospital attendance.
authors.affiliation: University Department of Surgery, Western Infirmary and Gartnavel General Hospital, Glasgow, UK.
authors.forename: S
authors.initials: S
authors.lastname: MacKenzie
authors.forename: J
authors.initials: J
authors.lastname: Norrie
authors.forename: M
authors.initials: M
authors.lastname: Vella
authors.forename: I
authors.initials: I
authors.lastname: Drummond
authors.forename: A
authors.initials: A
authors.lastname: Walker
authors.forename: R
authors.initials: R
authors.lastname: Molloy
authors.forename: D J
authors.initials: DJ
authors.lastname: Galloway
authors.forename: P J
authors.initials: PJ
authors.lastname: O'Dwyer
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration; D003108:Colonic Diseases / Q000191:economics / Q000628:therapy*; D003107:Colorectal Surgery / Q000191:economics / Q000458:organization & administration*; D003253:Consultants; D003365:Costs and Cost Analysis; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D011364:Professional Practice; D012017:Referral and Consultation