Factors Associated with Colonoscopy Performed in Nonhospital Settings

Alharbi, Othman; Rabeneck, Linda; Paszat, Lawrence; Wijeysundera, Duminda N.; Sutradhar, Rinku; Yun, Lingsong; Vinden, Christopher; Tinmouth, Jill

doi:10.1155/2010/151232

Cited by 7 publications

(8 citation statements)

References 18 publications

(20 reference statements)

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“…A previous Ontario study reported that the proportion of colonoscopies performed in private clinics increased from 10% to 15% between 1993 and 2005. 17 By 2013, that figure was 29%. However, it is not clear the extent to which this increase may have resulted in substantial improvements in access to colonoscopy for Ontario residents.…”

Section: Discussionmentioning

confidence: 98%

“…There has also been expansion of private endoscopy clinics in Ontario, which may improve access to colonoscopy by increasing system capacity and reducing wait times. At the same time, there are concerns around the quality of procedures performed in these private facilities, with evidence of lower completion rates and missed colorectal cancers 15–17. Thus, the objective of this study was to measure and describe the availability of colonoscopy resources in Ontario, Canada in the screening era and to evaluate the relationship between colonoscopy resource availability and utilisation.…”

Section: Introductionmentioning

confidence: 99%

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Regional variations and associations between colonoscopy resource availability and colonoscopy utilisation: a population-based descriptive study in Ontario, Canada

Webber

Flemming

Birtwhistle

et al. 2022

BMJ Open Gastroenterol

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ObjectiveThere 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.DesignWe 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.ResultsThere 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.ConclusionThe 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.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Regional variations and associations between colonoscopy resource availability and colonoscopy utilisation: a population-based descriptive study in Ontario, Canada

Webber

Flemming

Birtwhistle

et al. 2022

BMJ Open Gastroenterol

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“…The clinical setting, in which the index colonoscopy was performed, was identified using the hospital identifier in the CIHI databases, to determine if the setting was a teaching or a community hospital. If there was only an OHIP billing claim and no CIHI record of the colonoscopy, clinical setting was labeled as a nonhospital facility [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

Repeat Colonoscopy within 6 Months after Initial Outpatient Colonoscopy in Ontario: A Population-Based Cross-Sectional Study

Paszat

Sutradhar

Baxter

et al. 2017

Canadian Journal of Gastroenterology and Hepatology

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Background The goal of this study is to examine utilization of early repeat colonoscopy ≤ 6 months after an index procedure. Methods We identified persons having repeat colonoscopy ≤ 6 months following outpatient colonoscopy without prior colonoscopy ≤ 5 years or prior diagnosis of colorectal cancer (CRC). We modeled repeat colonoscopy using a generalized estimating equation with an exchangeable correlation structure to account for clustering of patients by endoscopist. Results The population included 334,663 persons, 7,892 (2.36%) of whom had an early repeat colonoscopy within 6 months. Overall, endoscopist prior year colonoscopy volume was inversely related to repeat ≤ 6 months. Repeat colonoscopy ≤ 6 months varied by the clinical setting of the index colonoscopy (adjusted OR = 1.41 (95% CI 1.29–1.55)) at nonhospital facilities compared to teaching or community hospitals. Among those who had polypectomy or biopsy, the adjusted OR for early repeat ≤ 6 months was elevated among those whose index colonoscopy was at a nonhospital facility (OR 1.44, 95% CI 1.30–1.60), compared to those at a teaching hospital or community hospital. Conclusions Repeat colonoscopy ≤ 6 months after an index procedure is associated with the clinical setting of the index colonoscopy.

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“…The proportion of procedures performed in private endoscopy centres across Canada is largely unknown. 34 Previous studies showed that, between 1993 and 2005, 84.4% of colonoscopy procedures performed in Ontario were done in hospitals, 11.4% were performed in nonhospital settings, and 4.1% were not classifiable. 35 Considering that most private endoscopy centres are in urban centres and are run by highvolume endoscopists, it is unlikely that including them would have changed the overall message of this study.…”

Section: Limitationsmentioning

confidence: 99%

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study

et al. 2018

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Background: Screening colonoscopy for the detection of colorectal carcinoma is provided by several specialties. Few studies have assessed geographic variation in the delivery of this care. Our objective was to investigate how geographic and socioeconomic factors affect who provides screening colonoscopy in Canada. Methods:This was a population-based cohort of all screening colonoscopy procedures performed at publicly funded Canadian health care facilities (excluding those in Quebec) between April 2008 and March 2015. The main outcome of interest was the proportion of colonoscopy procedures performed by surgeons versus gastroenterologists at the neighbourhood level. Predictors of interest included socioeconomic and geographic variables. We used spatial analysis to evaluate significant clustering of practitioner services and multinomial logistic regression to model predictors. Results:We identified 658 113 screening colonoscopy procedures performed by 1886 providers (1169 surgeons and 717 gastroenterologists) over the study period, of which 353 165 (53.7%) were performed by surgeons. A total of 24.2% of neighbourhoods were located within clusters predominantly served by gastroenterologists, and 19.5% were within surgeon clusters; the remainder were in mixed clusters. Rural neighbourhoods had a significantly increased relative risk of being within a surgeon cluster (relative risk [RR] 5.38, 95% confidence interval [CI] 3.48-8.01) compared to mixed clusters and nearly 100 times higher relative risk of being in a surgeon cluster compared to gastroenterologist clusters (RR 98.95,. Neighbourhoods with the highest socioeconomic status were 1.74 (95% CI 1.14-2.56) times likelier to be in gastroenterologist clusters than in mixed clusters.Interpretation: Surgeons provide a large proportion of colonoscopy procedures in Canada and are essential for access to care, particularly in rural regions. Most Canadians are served relatively equally by surgeons and gastroenterologists. This emphasizes the importance of both specialties to the delivery of colonoscopy care across the country. AbstractResearch OPEN CMAJ OPEN, 6(1) E127

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Factors Associated with Colonoscopy Performed in Nonhospital Settings

Abstract: Rates of NH-based colonoscopy are rising in Ontario. High-volume endoscopists and surgeons are most likely to practice in NH settings. Given its increasing use, further study of the practice and the regulation of NH colonoscopy is warranted.

Cited by 7 publications

References 18 publications

Regional variations and associations between colonoscopy resource availability and colonoscopy utilisation: a population-based descriptive study in Ontario, Canada

Regional variations and associations between colonoscopy resource availability and colonoscopy utilisation: a population-based descriptive study in Ontario, Canada

Repeat Colonoscopy within 6 Months after Initial Outpatient Colonoscopy in Ontario: A Population-Based Cross-Sectional Study

Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study

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