Evaluation of the introduction of indications and priority levels of Galician Health Service for colonoscopy in symptomatic patients: a prospective cross-sectional study

Background: the Galician Health Service established indications and priority levels (I = fast track, II = preferential, III = normal) for colonoscopy, according to the risk of colorectal cancer and significant colonic lesions detection with access from primary health care. Our aim is to show the results of the implementation. Methods: we included colonoscopies requested in symptomatic patients from June to October 2012 in a prospective observational cross sectional study. We collected health care level (primary, secondary), priority, appropriateness to the established criteria, wait times (from colonoscopy application and initial consultation) and diagnostic yield for colorectal cancer and/or significant colonic lesion. We compared health care levels in priorities I and II. Results: 425 colonoscopies were included (I = 221, II = 141, III = 63). The appropriateness rate to the protocol was 67.5 %. Priority levels were significantly associated to wait times (days) from application (I = 8.7 +/- 8.9, II = 50 +/- 20.3, III = 80.2 +/- 32.2; p < 0.001) and initial consultation (I = 32.2 +/- 38, II = 74.5 +/- 44.2, III = 128.5 +/- 47.4; p < 0.001), and with colorectal cancer (I = 20.1 %, II = 19.1 %, III = 4.8 %, p < 0.001) and significant colonic lesion (I = 35.3 %, II = 34 %, III = 19 %, p = 0.002) detection rates. In priority I and II, 21.8 % of colonoscopies were requested from primary health care. Referral form primary health care reduced wait times from initial consultation to colonoscopy (primary = 29.3 26, secondary = 55.2 48.6, p < 0.001). Instead, colorectal cancer (OR 2.41, 95 % CI 1.31-4.42) and significant colonic lesion (OR 1.88, 95 % CI 1.13-3.15) detection rate was increased. Conclusions: Galician Health Service priority levels are significantly associated with colorectal cancer and significant colonic lesion detection. Referrals to colonoscopy from primary health care reduce waiting times and increase diagnostic yield.