Page 118 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F1.5 Better Manage Growing Demands 10:45 Room 421

Direct Access Endoscopy Booking by Family Physicians: Evaluating a New Service Model and Clinical Predictors
of Positive Endoscopy Findings at Primary Care Setting
Leung LH, Cheung KL
Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong

Introduction
Dyspepsia is a common clinical problem affecting 10 – 20% of the population in the Asia Pacific region and can have a
variety of presentations e.g. pain, bloating, or gastroesophageal reflux (GERD). Around 15% of the Hong Kong primary
care patients receiving endoscopy revealed peptic ulcer disease. In Hong Kong, 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. Yet, the waiting time is very long. A further period of waiting time is required from the Specialist
Outpatient Clinic (SOPC) visit to the endoscopy appointment (SOPC-to-endoscopy time). In order to shorten the waiting time
for patients indicated for an endoscopy, a mode of open-access endoscopy was introduced in the UK in 1970s and was first
available in Hong Kong in 1990s. At the Kowloon West Cluster (KWC), the Sham Shui Po (SSP) district General Outpatient
Clinics (GOPCs) implemented the direct access endoscopy since late 2015 in collaboration with the Department of Surgery,
Caritas Medical Centre (CMC). OGDs, which were performed by designated surgeons, were arranged by GOPC doctors
directly after patients’ assessment. Post-OGD follow-up care would be offered by GOPC.
Monday, 7 May 2018 To evaluate a new direct access endoscopy model and the GOPC-to-endoscopy waiting time; (2) to review the endoscopic
Objectives

outcomes of patients under the direct access endoscopy programme; and (3) to idenfify clinical predictors for positive OGD
findings for patients presenting at a primary care setting.

Methodology
A retrospective cohort study was carried out from 1 October 2015 to 31 December 2016 since the GOPC direct access
endoscopy programme was started. Adult patients who had OGD booked directly at the five participating KWC GOPCs under
the direct access endoscopy programme in the study period were included. Data were presented as mean with SD, median
with interquartile range or count with percentage. Demographics and clinical characteristics variables of ulcer and non-ulcer
groups were compared using Chi-square test, Fisher’s exact test, independent t-test or Mann-Whitney U test. Variables with
P <0.1 in the simple logistics regression analysis were included in the multiple regression model. Adjusted odds ratio and
95% CI were calculated. A P-value of <0.05 was considered statistically significant.
Results
198 patients were arranged direct access endoscopy under the programme. 173 patients completed OGD (default rate
12.6%). The mean GOPC-to-endoscopy time was 14 weeks (23.7% completed within 8 weeks). 26 patients (15.0%) had
positive OGD findings (acute DU = 10; acute GU = 5; gastroduodeneal ulcer = 1; chronic DU = 3; oesophageal ulcer = 3;
benign neoplasm = 2; pre-cancerous lesion = 1; adenocarcinoma of stomach = 1). 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). From the
study, the direct access endoscopy model had shortened the GOPC-to-endoscopy time to a mean of 14 weeks as compared
with conventional GOPC-to-SOPC-to-endoscopy waiting time. Only 22 patients (12.7%) in the cohort required SOPC follow-
up and the rest of 87.3% patients were followed up by GOPC. The service had successfully identified serious pathologies
within a reasonable period of time. The study included analysis of clinical predictors namely ever smoking status, presence
of epigastric pain on history, and positive H. Pylori status which may be useful for the endoscopy queue triage purpose as
patients may not be presenting conventional red-flag symptoms at a primary care setting.

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