Direct access colonoscopy: impact of intervention on time to colorectal cancer diagnosis and treatment in North West Tasmania
| Autor: | Lucy Gately, Adrian Y.S. Lee, Sheryl Sim, Penny Allen, Garry Hamilton, Lavinia Tan, Patricia Banks |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Referral Colorectal cancer Colonoscopy Context (language use) Tasmania Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Intervention (counseling) Internal Medicine medicine Humans 030212 general & internal medicine Referral and Consultation Survival analysis Early Detection of Cancer Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry General surgery Emergency department Middle Aged medicine.disease Surgery Treatment Outcome 030211 gastroenterology & hepatology Female business Colorectal Neoplasms Time to diagnosis Follow-Up Studies |
| Zdroj: | Internal medicine journal. 47(10) |
| ISSN: | 1445-5994 |
| Popis: | Background Direct access colonoscopy (DAC) allows general practitioners to refer directly for colonoscopy, without specialist review. Research suggests DAC reduces times to diagnosis and treatment of colorectal cancer. However, there is no information about outcomes of DAC in Australia. Aims To determine if Direct Access Colonoscopy (DAC) in North-West Tasmania expedited colorectal diagnosis and treatment. Methods Pre-post intervention study evaluating time from referral to diagnosis and definitive treatment. Patient demographic characteristics, referral, colonoscopy and treatment information was retrieved from hospital records. Timelines were investigated in standard referrals (SR), Emergency Department (ED)/Inpatient referrals and DAC using survival analysis. Results 206 colorectal cancer cases were identified (115 SR, 26 DAC, 47 ED/inpatient and 15 unknown pathways). Median time to colonoscopy/diagnosis (DAC 6 weeks vs. SR 7 weeks, p=0.55) or definitive treatment (surgery/chemoradiation) (DAC 8 weeks vs. SR 9 weeks, p=0.81) was not significantly improved with DAC. Among SR only, time to diagnosis was 9 weeks pre-intervention vs. 5 weeks post-intervention (p=0.13), and time to treatment was 11 weeks pre-intervention vs. 6 weeks post-intervention (p=0.07). Conclusion There was no statistically significant improvement in time to colorectal cancer diagnosis or treatment among patients referred via DAC compared to standard referrals. There was a trend towards improved waiting times for standard referrals concurrent with the introduction of the DAC pathway, indicating improvement of all referral processes. DAC may not be effective at expediting colorectal cancer diagnosis if it is not accompanied by strict referral guidelines. Larger evaluations of DAC are required in the Australian context. |
| Databáze: | OpenAIRE |
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