Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Bruyère Research Institute, Ottawa, Ontario, Canada.
BMJ Open Gastroenterol. 2022 Jun;9(1). doi: 10.1136/bmjgast-2022-000929.
There is substantial variation in colonoscopy use and evidence of long wait times for the procedure. Understanding the role of system-level resources in colonoscopy utilisation may point to a potential intervention target to improve colonoscopy use. This study characterises colonoscopy resource availability in Ontario, Canada and evaluates its relationship with colonoscopy utilisation.
We conducted a population-based study using administrative health data to describe regional variation in colonoscopy availability for Ontario residents (age 18-99) in 2013. We identified 43 colonoscopy networks in the province in which we described variations across three colonoscopy availability measures: colonoscopist density, private clinic access and distance to colonoscopy. We evaluated associations between colonoscopy resource availability and colonoscopy utilisation rates using Pearson correlation and log binomial regression, adjusting for age and sex.
There were 9.4 full-time equivalent colonoscopists per 100 000 Ontario residents (range across 43 networks 0.0 to 21.8); 29.5% of colonoscopies performed in the province were done in private clinics (range 1.2%-55.9%). The median distance to colonoscopy was 3.7 km, with 5.9% travelling at least 50 km. Lower colonoscopist density was correlated with lower colonoscopy utilisation rates (r=0.53, p<0.001). Colonoscopy utilisation rates were 4% lower in individuals travelling 50 to <200 km and 11% lower in individuals travelling ≥200 km to colonoscopy, compared to <10 km. There was no association between private clinic access and colonoscopy utilisation.
The substantial variations in colonoscopy resource availability and the relationship demonstrated between colonoscopy resource availability and use provides impetus for health service planners and decision-makers to address these potential inequalities in access in order to support the use of this medically necessary procedure.
结肠镜检查的应用存在很大差异，且该检查的等候时间也很长。了解系统层面资源在结肠镜检查应用中的作用可能指向一个潜在的干预目标，以改善结肠镜检查的应用。本研究描述了加拿大安大略省结肠镜检查资源的可及性，并评估了其与结肠镜检查应用的关系。
我们使用行政健康数据进行了一项基于人群的研究，以描述 2013 年安大略省居民（18-99 岁）的结肠镜检查可及性的区域差异。我们在该省确定了 43 个结肠镜网络，描述了三种结肠镜检查可及性措施（结肠镜检查医生密度、私人诊所可及性和结肠镜检查距离）的变化。我们使用 Pearson 相关和对数二项式回归，调整年龄和性别后，评估了结肠镜检查资源可及性与结肠镜检查使用率之间的关联。
安大略省每 100000 名居民中有 9.4 名全职等效结肠镜检查医生（43 个网络的范围为 0.0 至 21.8）；该省进行的结肠镜检查中有 29.5%是在私人诊所进行的（范围为 1.2%-55.9%）。结肠镜检查的中位数距离为 3.7 公里，有 5.9%的人至少要行驶 50 公里。结肠镜检查医生密度较低与结肠镜检查使用率较低相关（r=0.53，p<0.001）。与距离<10 公里的人相比，距离 50-<200 公里的人的结肠镜检查使用率低 4%，距离≥200 公里的人的结肠镜检查使用率低 11%。私人诊所可及性与结肠镜检查使用率之间没有关联。
结肠镜检查资源的可及性存在很大差异，且资源可及性与使用之间的关系表明，卫生服务规划者和决策者有动力解决这些潜在的获得途径不平等问题，以支持这种必要的医疗程序的应用。
