title: Open-access gastroscopy in primary health-care offices to prevent peptic ulcer-related hospitalization and mortality.
abstract: BACKGROUND
  Open-access gastroscopy performed by general practitioners is available at some primary care health centres in our Central Finland hospital referral area. The aim of the present study was to examine whether this practice influences peptic ulcer-related hospitalization and mortality.
  
  
  METHODS
  Data on peptic ulcer-related hospitalization were obtained from discharge registries of the hospitals. Cause of death statistics were obtained from Statistics Finland Bureau.
  
  
  RESULTS
  In 1996--2001, 896 inhabitants living in our hospital referral area were hospitalized owing to peptic ulcer. Of these, 265 (29.6%) had an ulcer related to the use of aspirin (ASA) or non-steroidal anti-inflammatory drugs (NSAIDs). Among the hospitalized patients, mortality was 11.6% (n = 104). In municipalities with or without an open-access gastroscopy service, the rates of hospitalization were 49.1 cases/100,000/year (95% CI 44.8-53.4) versus 77.5 cases/100,000/year (95% CI 72.0-83.0), and ulcer-related mortality 5.6 cases/100,000/year (95% CI 4.1-7.1) versus 9.4/100,000/year (95% CI 7.5-11.3). In municipalities without the service, inhabitants were older and their overall morbidity and mortality higher than in municipalities offering open-access gastroscopy. Of patients under 75 years of age (n = 582), 48 (8.2%) died, compared with 56 (17.8%, P < 0.001) of patients aged 75 years or older (n = 314). Age was the only independent risk factor for death (odds ratio (OR) 1.03 per year (95% CI 1.02-1.05)). Among patients with ASA-NSAID-related ulcer, open-access endoscopy was protective against ulcer-related death (OR 0.17 (95% CI 0.03-0.85)).
  
  
  CONCLUSIONS
  Open-access gastroscopy in primary health-care offices significantly reduces ASA-NSAID-related ulcer mortality and may also reduce overall ulcer-related hospitalizations. The present results may, however, be biased by demographic factors. Age is a risk factor for death during ulcer-related hospitalization.
authors.affiliation: Dept of Internal Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland. markku.voutilainen@ksshp.fi
authors.forename: M
authors.initials: M
authors.lastname: Voutilainen
authors.forename: I
authors.initials: I
authors.lastname: Kunnamo
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D005260:Female; D005387:Finland / Q000453:epidemiology; D005773:Gastroscopy; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D011320:Primary Health Care; D012189:Retrospective Studies