2.2 Gastroscopy hospitalisations, all ages

The Atlas found the rate of hospitalisation for inpatient gastroscopy varied up to about seven-fold between local areas across Australia, in 2016-17. The pattern of use suggests overuse of gastroscopy in some areas. Lower rates of gastroscopy in outer regional and remote areas raise concerns about a lack of access to gastroscopy in these areas. The low rates for Aboriginal and Torres Strait Islander Australians raise similar concerns.

Aligning Medicare Benefits Schedule (MBS) items for gastroscopy with evidence-based criteria, together with auditing against the revised items, are important strategies that could be used to reduce inappropriate use of gastroscopy. Prioritising patients waiting for either colonoscopy or gastroscopy as a single group, rather than having separate lists, could improve the diagnostic yield from these investigations and improve patient outcomes. Education and audit for referrers could be a useful tool for improving appropriate use of gastroscopy, as could structured referral forms. Consumer education for women about the importance of excluding heavy menstrual bleeding in the management of anaemia may reduce unnecessary gastroscopy in this group.

Gastroscopy

2f. The Medicare Benefits Schedule (MBS) Review Taskforce to review descriptors for gastroscopy with evidence-based criteria using a consensus process. The taskforce to consider reserving subsidies for a set of specific indications for gastroscopy, including:

1. Upper abdominal symptoms that persist despite an appropriate trial of therapy
2. Upper abdominal symptoms associated with other symptoms or signs suggesting structural change (for example, difficulty swallowing), or new-onset symptoms in patients over 50 years of age.

2g. State and territory health departments to prioritise gastroscopy for individuals, consistent with the epidemiology of upper gastrointestinal cancer.

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

Content list: 

• Context
• About the data
  • Same-day procedure admission policies
  • Aboriginal and Torres Strait Islander identification
• What do the data show?
  • Magnitude of variation
  • Analysis by remoteness and socioeconomic status
  • Analysis by Aboriginal and Torres Strait Islander status
  • Analysis by sex
  • Gastroscopy and colonoscopy during the same hospitalisation
• Interpretation
  • Clinical decision-making
  • Access to endoscopy services
  • Rates of private health insurance
  • Other factors
• Addressing variation
  • Review of MBS item descriptions
  • Education and clinical audit
  • Concurrent gastroscopy and colonoscopy
  • Barrett’s oesophagus surveillance
  • Appropriate prioritisation of colonoscopy and gastroscopy
  • Consumer education
  • Reducing risk factors
  • Aboriginal and Torres Strait Islander Australians and gastroscopy