Authors (including presenting author) :
Tsang CF(1), Chan KW(1), Yiu MP(1), Lai PY(1), Cheung WW(1), Chan CW(1), Yiu YK(1), Luk W(1), Cheung WI(2), Wong WC(2), Chiu YW(3), Lau CN(3), Wong KW(4)
Affiliation :
(1) Department of Family Medicine and Primary Health Care, KWC, (2) Department of Medicine, Our Lady of Maryknoll Hospital, (3) Department of Surgery, Our Lady of Maryknoll Hospital, (4) Department of Surgery, Caritas Medical Centre.
Introduction :
Colorectal cancer is the leading cancer in Hong Kong and contributed about 17.3% of total cancer burden. Since Sep 2016 a colorectal cancer screening program has been launched and demand for lower GI endoscopy has increased more than ever, as reflected from the long waiting time in public hospitals. Family physicians can play a more active role in meeting the challenge. A team of family medicine specialists in HA (FM team) has started providing lower GI endoscopy service since 2008. With years of development and the support from medical and surgical GI specialist colleagues, the system has been solidly established, incorporating structured training, credentialing and quality assurance to monitor the performance.
Objectives :
To review the quality indicators, namely the overall adenoma detection rate, adjusted caecal intubation rate and complication rate in colonoscopies performed by the FM team. Comparison is made with overseas / international standard.
Methodology :
Data about colonoscopies performed by the FM team from year 2016 to 2018 are retrieved from CMS for review. Comparison is made with (1) international benchmark and (2) colonoscopies performed by primary care physicians in USA and Canada (referring to data from Wilkins T, et al. Screening Colonoscopies by Primary Care Physicians: a Meta-Analysis. Ann Fam Med. 2009 Jan-Feb).
Result & Outcome :
From year 2016 to 2018, 1841 patients received colonoscopy performed by the FM team. The mean age was 61 years old (Meta-Analysis: 59 years old). The reasons for performing the procedure included: presentation of colorectal symptoms such as PR bleeding or change of bowel habit, etc; for screening in high-risk groups; or for polyp surveillance. 30% were found to have one or more adenoma [International benchmark: >25%; Meta-Analysis: 28.9% (95%CI 20.4-39.3%)]. 2% were found to have cancer [Meta-Analysis: 1.7% (95%CI: 0.9%-3.0%)]. The adjusted caecal intubation rate was 97% [International benchmark: >90%; Meta-Analysis: 89.2% (95% CI 80.1-94.4%)]. There were 2 cases of post-polypectomy bleeding. Both were found to have mild thrombocytopenia. Both had colonoscopy again the same day with bleeding controlled and subsequently discharged the next day without further consequences. No perforation or death was reported. The overall rate of complication based on above was 0.1% [International benchmark: < 1% for post-polypectomy bleeding & < 0.2% for perforation. Meta-Analysis: 0.04% (95% CI, 0.01%-0.07%)]. To conclude, the quality of the colonoscopies performed by the FM team meet the international performance targets. Based on the results, colonoscopy service provided by trained FM specialists appears safe and effective in both quality and quantity.
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