Azzopardi J, DeWitt D E
University of Melbourne Rural Health Academic Centre-Melbourne Medical School, Victoria, Australia.
Rural Remote Health. 2012;12:1949. Epub 2012 Sep 13.
Colonoscopy remains the gold standard for the investigation and management of bowel pathology. A 2009 National Bowel Cancer Screening Program Quality Working Group report revealed that small rural towns in inner regional Victoria, Australia, for example Echuca (Rural and Remote Metropolitan Areas [RRMA] 4), registered 10.5 colonoscopies per 1000 population versus 18.5 per 1000 in the state capital Melbourne. Reasons for this discrepancy include lack of skilled practitioners in rural communities and travel time for patients to attend larger centres when the required bowel preparation or mobility issues limit access. Ideally, services are high quality, safe and local. This study assessed the quality and safety of a rural GP colonoscopy service.
The indications, findings, caecal intubation rates, complications and completion time were recorded for 3000 serial colonoscopies performed by one rural procedural GP from 1995 to 2011 in Victorian Echuca. Quality was assessed using caecal intubation rate, polyp and colorectal carcinoma detection rates, and completion time. Safety was determined by complication rates.
The caecal intubation rate was 97% (excluding stenosing lesions), polypectomy detection rate was 39%, carcinoma detection rate was 2%, and the average time to completion was 17 min. Re-admission rates were 1.6/1000 for haemorrhage and 1.2/1000 for perforation. There were no deaths.
The results from this study compare favourably with published international standards, validate Australian general practice procedural training standards, and validate the additional quality measure of 'colonoscopy completion time'. Rural GPs can provide a safe and high quality service. Extending this service model to similar settings could improve reduced access to colonoscopy for rural Australians.
结肠镜检查仍然是肠道疾病检查和管理的金标准。2009年国家肠癌筛查计划质量工作组的一份报告显示，澳大利亚维多利亚州内陆地区的一些小乡村城镇，例如伊丘卡（农村和偏远大城市地区[RRMA]4），每1000人口中有10.5例结肠镜检查，而州府墨尔本每1000人口中有18.5例。这种差异的原因包括农村社区缺乏熟练的从业者，以及当所需的肠道准备或行动不便限制了患者前往更大中心就诊时的出行时间。理想情况下，服务应高质量、安全且本地化。本研究评估了农村全科医生结肠镜检查服务的质量和安全性。
记录了1995年至2011年期间一位农村执业全科医生在维多利亚州伊丘卡为3000例连续结肠镜检查的适应证、检查结果、盲肠插管率、并发症和完成时间。通过盲肠插管率、息肉和结直肠癌检出率以及完成时间来评估质量。通过并发症发生率来确定安全性。
盲肠插管率为97%（不包括狭窄性病变），息肉切除检出率为39%，癌症检出率为2%，平均完成时间为17分钟。出血的再入院率为1.6/1000，穿孔的再入院率为1.2/1000。无死亡病例。
本研究结果与已发表的国际标准相比具有优势，验证了澳大利亚全科医生程序培训标准，并验证了“结肠镜检查完成时间”这一额外的质量指标。农村全科医生可以提供安全且高质量的服务。将这种服务模式推广到类似环境中可以改善澳大利亚农村地区结肠镜检查可及性降低的情况。
