GP practices with low referral rates for gastroscopy put patients at risk of worse outcomes, research shows

BMJ 2013; 346 doi: (Published 13 June 2013) Cite this as: BMJ 2013;346:f3855
  1. Jacqui Wise
  1. 1London

Rates of referral for endoscopy vary hugely between general practices in England, new research shows. Patients from practices with low referral rates are at increased risk of a poor outcome from oesophageal and gastric cancer, the researchers said.

The findings of the retrospective analysis of hospital episode statistics from 2006 to 2008 were presented at the annual conference of Public Health England’s National Cancer Intelligent Network this week. Researchers from the department of gastroenterology at the University of Liverpool looked at 22 488 new cases of oesophageal and gastric cancer from 6513 general practices and showed that average referral rates for endoscopy varied by 250%.1

They divided the practices into low, middle, and high mean rates of endoscopy referral (4.4, 8.1, and 12.9 referrals per 1000 patients, respectively). Patients with oesophageal or gastric cancer from practices with low rates of endoscopy referral had the highest mortality (death rates 61% in the low referral practices, 59% in the middle, and 58% in the high; P<0.001). Patients from the low referral practices also had the highest rate of emergency admission (34% versus 26% and 25%, respectively; P<0.001) and the lowest surgery rate (15% versus 16.3% and 17%; P<0.004). Inequality was most marked in practices serving deprived populations.

Keith Bodger, consultant gastroenterologist at Aintree University Hospital in Liverpool, said, “Our research shows that general practices in England vary substantially in their rates of gastroscopy and that low rates are associated with a risk of poorer outcomes for oesophageal and gastric cancer. This inequality is worst for those living in the most deprived areas of the country.”

Mick Peake, clinical lead at Public Health England’s National Cancer Intelligence Network, commented, “Rates of referral for endoscopy from primary care show wide variation, suggesting a spectrum of clinical practice and differing interpretation of guidelines.

“GP practices with low rates of endoscopy referral should review their current practice, particularly those serving deprived populations. Patients wherever they live should be given the best possible chance of a successful outcome. Increasing endoscopy rates and ensuring the right patients are referred early would be likely to significantly improve the outcomes for patients with oesophageal and stomach cancers.”


Cite this as: BMJ 2013;346:f3855


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