5.1 Gastroscopy MBS services, 18-54 years

Gastroscopy uses a small, flexible tube with a camera on the end to see inside a person’s upper gastrointestinal (GI) tract. It is used to:

• Investigate signs and symptoms that suggest bleeding, cancer or other conditions of the oesophagus and stomach and upper small bowel
• Treat or monitor certain GI conditions.

Gastroscopy is not normally used to investigate uncomplicated reflux.

The Third Atlas 2018 found higher hospitalisation rates for gastroscopy among people who live in areas of socioeconomic advantage in major cities, and in women. This is not consistent with the prevalence of GI disease.

The Fourth Atlas 2021 examines gastroscopy services that are subsidised under the Medicare Benefits Schedule (MBS) in people aged 18–54 years. Most upper GI tract conditions that require a gastroscopy are uncommon in this age group.

In 2018–19:

• There were 154,338 MBS-subsidised services for gastroscopy for people aged 18–54 years, representing 1,247 services per 100,000 people aged 18–54 years (the Australian rate)
• The number of MBS-subsidised services for gastroscopy across 327 local areas ranged from 218 to 2,348 per 100,000 people
• The rate of MBS-subsidised services for gastroscopy was 10.8 times as high in the area with the highest rate compared with the area with the lowest rate
• The rates were much higher in major cities than other areas, and much lower in remote areas. The rate for major cities was 3.4 times as high as the rate for remote areas
• Rates decreased with socioeconomic disadvantage in most areas. Overall, the rate in the highest socioeconomic group was 1.4 times as high as the rate in the lowest
• The national rate for women was 1.6 times as high as the rate for men
• About 6 in every 10 gastroscopy services were performed on the same day as a colonoscopy service for the same person.

Rates are standardised to remove age and sex differences between populations.

Wide variation in gastroscopy use probably means overuse in some areas and underuse in others. Variation in rates of gastroscopy is likely to be due to differences in:

• Clinical decision-making – lack of national guidance on the use of gastroscopy leading to variation in practice; variation in adherence to available guidelines. The ease of performing a gastroscopy with a colonoscopy on the same day may unduly affect decision-making on whether a gastroscopy is needed
• Inappropriate referral practices, which may lead to overuse
• Consumer expectations – lack of understanding about the role of gastroscopy; perception of cancer risk and anxiety about developing upper GI cancer
• Access to services and clinicians – these may not be available or affordable for some people
• Over-servicing – higher payments are available for providing a service rather than a consultation.

Develop national guidance to support appropriate use of gastroscopy.

Develop evidence-based triage systems for prioritising and allocating people for gastroscopy and colonoscopy.

Improve clinicians’ skills in diagnosis (for example, assessment of iron deficiency in menstruating women) through audit and education.

Educate consumers about the limited role of gastroscopy in the management of most upper GI symptoms.

Educate consumers about the low incidence of upper GI cancer in people under 55, and lifestyle factors that can reduce this risk.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

5a. State and territory health departments to develop and implement evidence-based triage criteria for the prioritisation and allocation of patients to gastroscopy, colonoscopy, and gastroscopy performed with colonoscopy.

5b. Health service organisations to:



i. Audit clinicians performing endoscopy services and provide the results back to clinicians to act upon, in line with Action 1.28 of the National Safety and Quality Health Service (NSQHS) Standards



ii. Incorporate individual clinicians’ audit data as part of re-credentialing processes



iii. Report key performance indicators, trends and adverse events in endoscopy to the governing body, consistent with the NSQHS Standards.

5c. The Gastroenterological Society of Australia to develop a position statement on the appropriate use and timing of gastroscopy, and of gastroscopy performed with colonoscopy, for gastroenterologists and general practitioners.

Download the Gastroscopy MBS services, 18–54 years section of the Atlas to read more about context, data, key findings, interpretation and addressing variation:

Contents:

Context

• What is gastroscopy?
• What is it used for?
• Why examine gastroscopy in people aged 18–54 years?

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Number of MBS services for gastroscopy and colonoscopy for the same patient on the same day
• Analysis by sex

Interpretation

• Clinical decision-making
• Gastroscopy and colonoscopy performed on the same day
• Referral practices
• Consumer expectations
• Access to services and number of clinicians providing services
• Financial incentives

Promoting appropriate care

• Guideline and resource development
• Clinical decision-making
• Consumer education and reassurance
• Reducing lifestyle factors
• Clinical audit and clinician education
• Appropriate prioritisation of colonoscopy and gastroscopy
• Triage systems

Resources

Australian initiatives

References