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

Abstract

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.

The impact on clinical outcomes and healthcare resources from discontinuing colonoscopy surveillance subsequent to low-risk adenoma removal: A simulation study using the OncoSim-Colorectal model

“…Fewer annual colonoscopies may reduce colonoscopy wait times, thereby reducing patient anxiety 32 and preventing delays in CRC diagnosis. 33,34 Colonoscopy wait times throughout Canada currently exceed the medically recommended time periods for patients with positive FIT [35][36][37] and for patients with CRC symptoms, 34,38 which has been exacerbated by interruptions in medical services due to the coronavirus disease 2019 pandemic. 39 Fewer annual colonoscopies may also reduce patient's time lost from normal activities 40 and reduce colonoscopy-related morbidity.…”

A Real-Time Endoscope Motion Tracker

“…Third, gastrointestinal endoscopy screening and surveillance, especially colonoscopy, is a whole population scale program with high volume. Both cost in equipment/facilities and access to qualified endoscopists should be considered when new technologies are developed [7] . The reported endoscope tracker is designed to be an add-on auxiliary device that is compatible with most endoscopes on the market.…”

“…In the United States, CRC is the third most commonly diagnosed cancer for both men and women with an estimated 151,030 new cases occurring in 2022 [5] , [6] . Besides equipment costs, access to qualified endoscopists is a key barrier to rolling out systematic screening world-wide [1] , [7] . During screening and surveillance colonoscopy, an endoscope is used to detect and remove precancerous lesions, such as polyps, to prevent them from developing into malignant CRC [8] , [9] , and large tumors are biopsied for histological testing.…”