IDDF2018-ABS-0046 Direct access endoscopy booking by family physicians: evaluating a new service model and clinical predictors of positive endoscopy findings at primary care setting

Abstract

Background Dyspepsia is a common clinical problem in the Asia-Pacific region and can have a variety of presentations. Patients who have dyspepsia and need an oesophagogastroduodenoscopy (OGD) are referred by their primary care doctor to surgeons or gastroenterologists, who would perform the OGD. In order to shorten the waiting time for patients indicated for an endoscopy (GOPC-to-endoscopy time), a mode of open-access was first available in HK in the 1990s. At the Kowloon West Cluster (KWC), five GOPCs implemented direct access endoscopy since late 2015 in collaboration with Department of Surgery, Caritas Medical Centre. OGDs, which were performed by designated surgeons, were arranged by GOPC doctors directly. Post-OGD follow-up care would be offered by GOPC. Objectives To evaluate direct access endoscopy model and GOPC-to-endoscopy waiting time. To review endoscopic outcomes of patients under direct access endoscopy programme. To identify clinical predictors for positive OGD findings for patients presenting at primary care setting. Methods A retrospective cohort study from 1 st Oct 2015 to 31st Dec 2016. Adult patients who had OGD booked under the programme were included. Demographics and clinical characteristics variables were compared. Variables with p Results 198 patients were arranged direct access endoscopy. 173 patients completed OGD. The mean GOPC-to-endoscopy time was 14 weeks (23.7% within 8 weeks). 26 patients had positive OGD findings including ulcer and neoplastic conditions, one of which was stomach adenocarcinoma. Clinical predictors for a positive OGD included ever smoking status (adjusted OR 3.15; 95% CI 1.00–9.86; P 0.049), presence of epigastric pain on history (adjusted OR 3.32; 95% CI 1.19–9.26; P 0.022) and a positive H Pylori status (adjusted OR 3.60; 95% CI 1.39–9.36; P 0.009). Conclusions Direct assess endoscopy in primary settings may have a role in early detection of significant pathologies. Clinical predictors may be useful for triage purpose as the patient may not present classical red flags symptoms in primary settings.