A comparison of hospital and nonhospital colonoscopy: wait times, fees and guideline adherence to follow-up interval |
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Authors: | Ivers Noah Schwandt Michael Hum Susan Martin Danielle Tinmouth Jill Pimlott Nick |
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Institution: | 1Family Practice Health Centre, Women’s College Hospital;;2Department of Family and Community Medicine, University of Toronto;;3Dalla Lana School of Public Health, University of Toronto;;4Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre;;5Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario |
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Abstract: | BACKGROUND:Although colonoscopy is increasingly performed in nonhospital facilities, studies to date examining differences between colonoscopy services in hospital and nonhospital settings have been limited, in large part, to administrative databases.OBJECTIVES:To describe the experiences of patients receiving colonoscopy in hospital and nonhospital settings, and to compare these settings with respect to wait times and recommended follow-up interval to the next colonoscopy.METHODS:A postal survey of 2000 patients, 50 to 70 years of age, from an urban academic family practice was conducted. Most recent colonoscopy was classified as either occurring in a hospital or nonhospital setting. Multivariable logistic regression analysis was used to examine the association among wait times, follow-up intervals and patient factors with respect to colonoscopy setting.RESULTS:Patients who underwent their most recent colonoscopy outside of a hospital were more likely to be men (P=0.01) and to have undergone more than one previous colonoscopy (P=0.02). For patients with a normal screening colonoscopy and no family history of colorectal cancer or polyps, nonhospital clinics less often recommended a 10-year follow-up interval (OR 0.13 95% CI 0.04 to 0.47]). Reported wait times at nonhospital clinics were shorter for patients receiving screening colonoscopy (OR 2.11 95% CI 1.28 to 3.47]), but not for symptomatic patients (OR 1.74 95% CI 0.88 to 3.43]). For individuals attending nonhospital clinics, 10% were referred from a hospital by the same specialist performing the procedure; 31.7% reported paying a fee.CONCLUSION:Nonhospital clinics were far less likely to adhere to guidelines regarding follow-up intervals for low-risk patients. Given the implications for both health care costs and patient safety, further study is needed to determine the cause of this disparity. |
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Keywords: | Colonoscopy Health care surveys Quality of health care |
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