5.2 Repeat colonoscopy MBS services, all ages

Colonoscopy uses a small, flexible tube with a camera on the end to see inside a person’s large bowel (colon). It is used to investigate bowel problems or symptoms. It can also include removing small growths called polyps, which can become cancer.

Repeat colonoscopy is mainly used to check for polyps and bowel cancer in people with a higher risk of bowel cancer. There are limited reasons why a colonoscopy would be repeated within 3 years.

The First Atlas 2015 and the Third Atlas 2018 found large variation in rates of colonoscopy. One of the possible reasons for variation is differences in adherence to guidelines about repeating colonoscopies.

The Fourth Atlas 2021 examines rates of colonoscopy 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 147,875 MBS-subsidised services for repeat colonoscopy performed within 2 years and 10 months in people of all ages, representing 522 services per 100,000 people of all ages (the Australian rate)
• The number of MBS-subsidised services for repeat colonoscopy across 324 local areas ranged from 62 to 1,236 per 100,000 people
• The rate of MBS-subsidised services for colonoscopy was 19.9 times as high in the area with the highest rate compared with the area with the lowest rate. The rate for major cities was 3.2 times as high as the rate for remote areas
• Rates were much higher in major cities than other areas, and increased with socioeconomic advantage in major cities. Overall, the rate in the highest socioeconomic group was 1.6 times as high as the rate in the lowest
• 139,072 people had at least one MBS-subsidised service for repeat colonoscopy, representing 491 per 100,000 people of all ages
• There were 71,464 MBS-subsidised services for repeat colonoscopy without polyp removal, representing 257 services per 100,000 people of all ages. This was 49% of repeat colonoscopies, and varied across states and territories.

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

Variation in rates of repeat colonoscopy is likely to be due to differences in:

• Clinical decision-making – not all clinical decisions may be supported by guidelines
• Poor bowel preparation, which results in poor-quality colonoscopy that needs to be repeated
• Consumer expectations and understanding about their risk of bowel cancer and the rate of its development
• Access to services and clinicians – services and clinicians may not be available or affordable for some people. This includes the ability to pay out-of-pocket costs
• Over-servicing – higher payments are available for providing a service rather than a consultation.

Improve consistent use of national guidelines on bowel cancer screening and surveillance, including:

Implement the Colonoscopy Clinical Care Standard to improve appropriate use of colonoscopies. This could reduce inappropriate requests for repeat colonoscopies and free up services for people at high risk of bowel cancer.

Clinicians could use structured referral forms to help assess requests for repeat colonoscopies against guidelines. Promote high quality colonoscopy and improve clinicians’ decision-making about repeat colonoscopies through clinical audit and education.

Educate consumers about how they can reduce their risk of bowel cancer, and that progression from polyp formation to bowel cancer is slow.

Develop evidence-based triage systems for prioritising and allocating people for gastroscopy and colonoscopy, based on clinical need.

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 colonoscopy MBS services, all ages section of the Atlas to read more about context, data, key findings, interpretation and addressing variation:

Contents:

Context

• What is colonoscopy?
• What is it used for?
• When does a colonoscopy need to be repeated?
• Why examine repeat colonoscopy?

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 colonoscopy
• Analysis by number of MBS-subsidised services for repeat colonoscopy without polyp removal

Interpretation

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

Promoting appropriate care

• Quality colonoscopy and clinical audit
• Clinician education
• Consumer education and reassurance
• Reducing risk factors
• Triage systems
• Promoting existing initiatives

Resources

Australian initiatives

References