New standard provides up-to-date guidance on colonoscopy referral and care

Amanda Lyons

11/09/2018 2:29:20 PM

The Australian Commission on Safety and Quality in Health Care’s Colonoscopy clinical care standard is aimed at reducing unnecessary procedures and improving care at every stage of the process.

ACSQHC Clinical Director Prof Anne Duggan launched the Colonoscopy clinical care standard at the Australian Gastroenterology Week 2018 conference in Brisbane.
ACSQHC Clinical Director Prof Anne Duggan launched the Colonoscopy clinical care standard at the Australian Gastroenterology Week 2018 conference in Brisbane.

The Colonoscopy clinical care standard (the standard) was launched by the Australian Commission on Safety and Quality in Health Care (ACSQHC) yesterday at the Australian Gastroenterology Week 2018 conference in Brisbane.
While the new document is designed to be quick and easy for clinicians to consult, it is the result of many months of hard work from healthcare professionals and consumer representatives.
‘We spent more than a year putting these clinical care standards together, with the key players in the field: the RACGP, anaesthetists, nurses, gastroenterologists, surgeons, consumers and operators at private hospitals,’ ACSQHC Clinical Director Professor Anne Duggan told newsGP.
Professor Jon Emery, GP and Herman Professor of Primary Care Cancer Research at the University of Melbourne and Western Health, was involved in the early stages of the standard’s development. He has a clear view of its purpose.
‘This is about saying what we should expect across the whole health system, from a patient point of view, from a GP point of view, from the colonoscopist’s point of view, and from the health service provider,’ he told newsGP.
The standard’s development was triggered by a large growth in demand for colonoscopy across Australia, as well as significant discrepancies in use of the procedure between regions.
‘[There were] concerns about overuse of colonoscopy, particularly in patients who may not meet the current guideline recommendations for requiring it,’ Professor Emery said.
Overuse of colonoscopy can have a number of unwelcome consequences for patients, such as increasing anxiety with false positives. The procedure itself also comes with its own risks.
‘The procedure requires sedation, so if the patient has comorbidity, there’s risk there,’ Professor Duggan said.
‘Also, perforation of the whole bowel or bleeding of the rectal passages are real complications. And we know that, as the sedation wears off, people fall when they’re not alert. So it’s very important that quality post-procedure care occurs.’
Overuse of colonoscopy also comes with consequences for the broader health system.
‘Another other big harm is the community cost,’ Professor Duggan said. ‘If some people are having colonoscopy when they don’t need it, that means other people aren’t getting colonoscopy in a timely fashion.’
The new standard aims to reduce this harm by providing guidance on every stage of the colonoscopy process, from diagnosis and referral to aftercare. Professor Duggan believes GPs are a particularly important audience, as they are often the first health professional consulted by patients in matters relating to bowel health.
‘GPs are a pivotal part in this, as they are the continuity of care, and consumers tend to trust their GP more than anyone else,’ she said.

Prof-Jon-Emery-hero-(2).jpgProfessor Jon Emery says the standard was developed, in part, due to concerns about overuse of colonoscopy.
The standard includes easy access to the most up-to-date information around diagnosis and referral from National Health and Medical Research Council (NHMRC) and Cancer Council resources.
‘It’s about trying to ensure that patients who require a colonoscopy are adequately identified in primary care, particularly in light of the concerns about over-referral of people who don’t meet the criteria,’ Professor Emery said.
The standard also targets improved communication between GPs and other specialists.
‘The aim is to give the GP all the information they need to be able to manage their patient really well and to have conversations with them about when they should have their next procedure, if they need one,’ Professor Duggan explained.
Such guidance also applies to information travelling the opposite way, to specialists from GP referrals.
‘There’s discussion around referral templates, including electronic templates, to improve the quality of referral information at the point of decisions around colonoscopy,’ Professor Emery said. ‘That is really important to ensure services can accurately triage patients as to how urgently they require the procedure.’
The standard also has a strong consumer focus to help boost patients’ health literacy regarding colonoscopy and its risks and benefits.
‘I think it will be very good in informing patients about the care they can expect to receive, and that they have the opportunity to ask questions, make an informed decision and talk about their options,’ Professor Duggan said.
Professor Duggan is also keen to highlight that the best preventive measure for bowel cancer is still to be found in primary care.
‘We need to remember that about 50% of bowel cancer risk is about lifestyle factors,’ she said.
‘We should be making sure we’re informing patients about what they can do to prevent themselves getting bowel cancer by eating well, not being overweight, not smoking, and not drinking alcohol.
‘I would hate us to forget that primary prevention component.’

ACSQHC bowel cancer colonoscopy Colonoscopy clinical care standard

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Margaret McGlinn   23/08/2019 3:29:54 PM

Is there a colonoscopy procedure being used in Australia by way of a Chip being inserted into the body to go around the body & send back images to a monitor . Thank you