title: A survey of open-access endoscopy in primary health care centres: outcome of gastric carcinoma patients diagnosed by general practitioners compared with hospital-referred endoscopy.
abstract: BACKGROUND
  We examined open-access endoscopy service based on general practitioner endoscopists.
  
  
  METHODS
  We compared the survival of the gastric carcinoma patients originally diagnosed in health care centres by general practitioner endoscopists and hospital outpatient clinic by specialists.
  
  
  RESULTS
  A total of 159 gastric carcinoma cases diagnosed during 1996-2000 were included in to the present study. Of them, 58% (N = 92) and 42% (N = 67) were detected by general practitioners and specialists, respectively. We observed no difference in the mean age of patients (71.3 years versus 71.4 years, p = 0.97) and stage of tumours [15% (N = 14) versus 21% localised tumours (N = 14, p = 0.30)] between cases diagnosed by general practitioners and specialists. The number of patients who underwent radical extirpation were 14% (N = 13) and 19% (N = 13, p = 0.38), respectively. After a minimum follow-up of 3.5 years, 29 patients (18%) were alive. The mean survival time of hospital-diagnosed carcinoma patients was longer (23.6 months versus 18.7 months, p = 0.23). Eight patients had undergone hospital-referred gastroscopy less than 3 years before cancer diagnosis. In multivariate analysis, radical extirpation of carcinoma (odds ratio 0.11, 95% confidence interval 0.04-0.28) predicted survival; whereas age (odds ratio 1.03 per year, 95% confidence interval 0.99-1.07 per year), female sex (odds ratio 1.785, 95% confidence interval 0.71-4.81) and the open-access endoscopy based on general practitioner endoscopists (odds ratio 1.48, 95% confidence interval 0.60-3.65) predicted neither survival nor carcinoma-related death.
  
  
  CONCLUSIONS
  No significant difference was detected in the outcome of gastric cancer patients diagnosed in primary care centres by general practitioner endoscopists and in hospital outpatient clinic by specialists.
authors.affiliation: Department of Internal Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, FIN-40620 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: D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010821:Physicians, Family / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D013274:Stomach Neoplasms / Q000175:diagnosis*