5.3 Repeat gastroscopy MBS services, all ages

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, stomach and upper small bowel.
• Treat or monitor certain GI conditions, such as Barrett’s oesophagus (a condition in which the cells change in the lining of the oesophagus, and which can lead to oesophageal cancer in some people).

There are only a few clinical reasons why a gastroscopy would be repeated within 3 years.

The Third Atlas 2018 found large variation in gastroscopy hospitalisations. One of the possible reasons for variation is the use of gastroscopy for monitoring. Differences in how often gastroscopy is repeated for monitoring the same GI condition may be affecting rates.

The Fourth Atlas 2021 examines rates of gastroscopy services that are subsidised under the Medicare Benefits Schedule (MBS) and are repeated within 3 years in people of all ages.

In 2018–19:

• There were 87,933 MBS-subsidised services for repeat gastroscopy performed within 2 years and 10 months, representing 314 services per 100,000 people of all ages (the Australian rate)
• The number of MBS-subsidised services for repeat gastroscopy across 321 local areas ranged from 61 to 908 per 100,000 people
• The rate of MBS-subsidised services for repeat gastroscopy was 14.9 times as high in the area with the highest rate compared with the area with the lowest rate
• Rates were much higher in major cities than elsewhere. The rate for major cities was 3.7 times as high as the rate for remote areas.
• Rates increased with socioeconomic advantage everywhere apart from outer regional areas. Overall, the rate in the highest socioeconomic group was 1.6 times as high as the rate in the lowest.
• 81,893 people had at least one repeat MBS-subsidised service for gastroscopy, representing 292 people per 100,000 people of all ages.

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

Variation in rates of repeat 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 clinician adherence to available surveillance guidelines
• 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 – services and clinicians may not be available or affordable for some people
• Over-servicing – higher payments are available for providing a service rather than consultation.

Develop national guidance to support appropriate use of gastroscopy.

Educate consumers about generally low risk of upper GI cancer, and lifestyle factors that can reduce this risk.

Improve clinicians’ decision-making about repeat gastroscopies through clinical audit and education.

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

Promote initiatives such as Choosing Wisely, which includes a recommendation for frequency of gastroscopy to monitor Barrett’s oesophagus

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 Repeat gastroscopy MBS services section of the Atlas below, to read more about the context, data, key findings, interpretation, and addressing of variation for this clinical item:

Contents:

Context

• What is gastroscopy?
• When does a gastroscopy need to be repeated?
• Why examine repeat gastroscopy?

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by number of people who had at least one repeat gastroscopy
• Analysis by Primary Health Network

Interpretation

• Clinical decision-making
• Consumer expectations
• Access to services and number of clinicians providing services
• Financial incentives

Promoting appropriate care

• Guideline and resource development
• Consumer education and reassurance
• Reducing risk factors
• Clinical audit and clinician education
• Appropriate prioritisation of services
• Triage systems
• Promotion of existing initiatives

Resources

Australian initiatives

References