Report reveals growing divide in colonoscopy access

Better communication between medical professionals and with patients could help ensure people are sent for colonoscopies within the appropriate clinical window, according to the Australian Commission on Safety and Quality in Health Care (ACSQHC).
 
The advice comes as an analysis by the Commission indicates some patients might not be having an initial or repeat colonoscopy at the right time.
 
The ACSQHC launched an updated Colonoscopy Clinical Care Standard at the World Congress of Gastroenterology in Melbourne on Sunday, which provides guidance to ensure procedures are safe and of high quality.
 
Key changes address difficulties in accessing previous patient results, which can lead to confusion and unnecessary repeat colonoscopy, as well as emphasising better communication at referral and in the sharing of reports with patients and GPs.
 
The Commission also released an interactive tool, the Atlas Focus Report: Colonoscopy, which provides localised MBS data on colonoscopy and repeat colonoscopy between 2013−14 and 2023−24.
 
Together, the resources show a disparity in access to colonoscopy across Australia as well as opportunities for improvement in patient care.
 
Australians undergo around one million colonoscopies each year, with timing of repeat procedures depending on previous results and risk factors.
 
If Cancer Council guidelines are followed, only a small proportion of patients will need a repeat colonoscopy before three years, the ACSQHC explains.
 
Yet the Commission’s findings indicate repeat colonoscopies may be occurring too soon in some patients, while others are completely missing out on this important test to help prevent and detect bowel cancer early.
 
While survival rates continue to improve, the Atlas data reveals mortality rates are higher outside major cities and in lower socioeconomic areas – also where colonoscopy rates are consistently lower.
 
The report also shows the national rate of repeat colonoscopy before three years decreased by 8% in the past decade to 2023–24, with rates falling most in remote areas (down 26%) and areas of most socioeconomic disadvantage (down 17%).
 
Disparities were also seen in overall colonoscopy rates in 2023–24, which were four times as high in major cities than remote areas (2550 compared with 633 per 100,000 people), while rates in more affluent areas were nearly double those in areas of most socioeconomic disadvantage (3067 compared with 1675 per 100,000 people).
 
ACSQHC CEO and gastroenterologist, Conjoint Professor Anne Duggan, said it is crucial that all Australians undergo colonoscopy at the right time for an initial or a repeat colonoscopy.
 
‘The Atlas Focus Report highlights a widening gap in colonoscopy rates,’ she said.
 
‘People living in cities and more affluent areas are having more colonoscopies than those in both rural and disadvantaged areas.
 
‘We want to make sure every colonoscopy is done for the right reason, at the right time and to the highest quality.’
 
GP and ACSQHC Medical Adviser, Dr Phoebe Holdenson Kimura, says the revised standard aims to support this goal.
 
She said improved communication between medical professionals and with patients was crucial, and the new standard addresses the communication difficulties that can lead to confusion and, at times, unnecessary repeat colonoscopy.
 
‘There’s an increased emphasis in the Clinical Care Standard this time on the importance of high-quality referrals – this means assessment of symptoms, physical examination, investigations, ordering of investigations,’ Dr Holdenson Kimura told newsGP.
 
‘The more that the GP can hand over to the colonoscopist about the patient’s general medical history – any medications that they’re on and their clinical concern around their symptoms – the more it can help the colonoscopist arrange a timely colonoscopy and triage it appropriately.’
 
The revised standard also strengthens guidelines around discharge, Dr Holdenson Kimura said.
 
‘We know that sometimes the patient has had a colonoscopy done, but they come out of having a procedure not feeling entirely clear on what happened, what was seen by the colonoscopist, or what the follow-up recommendations might be,’ she said.
 
‘So we’ve strengthened the guidance for the colonoscopist to be really proactive in communicating, both verbally and in written form, to the patient … but also being proactive about communicating to the patient’s regular GP in writing, and being really clear as to what the surveillance interval might be, if there is one, and then to upload the report as well into the electronic medical record, and ideally My Health Record.’
 
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