Providing endoscopy for underserved patients benefits public health and resident education.

OBJECTIVE

To determine the clinical and educational value of a new model for providing endoscopy for medically indigent patients.

HYPOTHESIS

A model can be developed at minimal cost to provide essential endoscopy services for underserved patients while providing resident education.

DESIGN

In our community, there was limited access to endoscopy for indigent patients, and surgical resident endoscopy experience was inadequate. To address these problems, a new endoscopy program was developed. Procedures were performed during underused times in a hospital endoscopy clinic. Endoscopies were performed on patients referred from the public health clinics. All procedures were performed by senior surgical residents supervised by attending endoscopists. The data were collected over 30 months. Colonoscopies were performed for both diagnostic and screening purposes.

INTERVENTIONS

In all, 205 colonoscopies, 65 upper endoscopies, and 14 combined endoscopies were performed.

OUTCOME MEASURES

Positive findings on endoscopy were documented. The cost-effectiveness was calculated.

RESULTS

Of 205 colonoscopies, 35% had positive findings. Sixty-six (32%) patients had polyps and 6 (3%) patients had carcinomas. Of 65 upper endoscopies, 34 (55%) patients had positive findings. Thirty (47%) patients had moderate to severe gastritis/esophagitis or ulcers, 2 (3%) patients had esophageal varices, 2 (5%) patients had carcinomas, 10 (15%) patients had positive H. pylori biopsies, and 2 (3%) patients had Barrett's esophagus. The program incurred minimal incremental costs, and large cost savings were realized in prevention and early detection of colon and gastric carcinomas.

CONCLUSIONS

Our 30-month experience resulted in clinical benefits to patients at minimal incremental cost while reducing future medical costs by preventing and detecting disease. Surgical residents received essential training.