TableA.3 Developments in service delivery: summary of articles examined for secondary services

ID and authorsResearch setting and year of studyStudy designSample sizeTopic of documentKey results and conclusionsLevel of evidenceQuality score (AGREE) (%)
Provenzale et al704International (1980–98)Literature review2157 Articles; 10 includedSpecialised and general GI careGastroenterologists may provide better care than other provider types for certain disorders180
Williams et al491UK (2001–04)RCT and cost effectiveness study1800Nurse endoscopyNurses are clinically as effective as doctors but preferred by patients1
Delaney et al724UK (1995–98)RCT442 PatientsCost effectiveness of endoscopy for patients over 50Initial endoscopy in dyspeptic patients over 50 years of age might be a cost effective intervention2+77
CRD560UK (2004)Commentary; review of evidenceAround 190 articlesManagement of colorectal cancersNurse endoscopy (predominantly flexible sigmoidoscopy) is not uncommon and levels of satisfaction among patients using nurse-led endoscopy clinics are consistently high. Where accuracy of diagnosis is reported, GPs and nurses who have received appropriate training perform as well as surgeons and gastroenterologists. A survey found that nurses carried out endoscopy in 43% of 176 units. The comparison between endoscopy performed by doctors and nurses showed equally good outcomes. Complications were not reported in any of these studies2+59
Pathmakanthan et al711UK (2000)Survey of clinicians176 ResponsesNurse endoscopists in the UKNurse endoscopy is widely practised in the UK and is not limited to one procedure or carried out solely for diagnostic purposes. Perceived benefits include the reduction of waiting lists, reported good patient acceptability, improved care and safety. Most clinicians foresee a role for nurse endoscopy in the provision of endoscopic services, albeit in a limited capacity2−70
Aly et al705UK (1999)Survey of clinicians538 ResponsesNon-compliance with guidelinesIt was clear in this study that the practice of hepatobiliary and pancreatic (HBP) specialists was more in keeping with UK guidelines than the practice of non-specialists. Non-specialists for whom guidelines might have most to offer by providing an easily accessible source of accumulated evidence and conclusions seem to have taken least heed of the advice offered. These results have implications for the rationale of creating guidelines, and for the strategies associated with their introduction2−66
Smale et al712UK (2000–01)Analysis of routine data; survey3489 PatientsUpper GI endoscopy performed by nursesExperienced nurses perform routine diagnostic gastroscopy safely in everyday clinical practice and with as little discomfort and as much patient satisfaction as medical staff2−66
Quirk et al707USA (1994–95)Retrospective study; analysis of routine data124 PatientsPhysician specialtyPatients admitted to hospital under the care of a gastroenterologist had shorter hospital stays that were less costly than patients under the primary care of general internists or surgeons2−64
Bohra et al706Dublin, UK (2000)Analysis of routine data242 CasesAnalysis of GI servicesWe recommend that patients are seen at the initial consultation by a registrar/fellow in most cases, and at a follow-up consultation before discharge. Specialisation helps to improve quality of care, stimulates thought, aids training of junior doctors, and leads to cost savings, but constitutes a substantial workload for the gastroenterologist owing to endoscopic procedures and patient follow-up2−57
McKinlay et al713UK (2003)Expert commentary and recommendations; survey of clinicians28 GI units; 67 GI consultantsModernisation of the gastroenterology service in ScotlandA rapid expansion of the specialist GI nurse numbers mix is required to include endoscopy training where locally important to case mix. A large number of units in Scotland would like to employ more specialist nurses, particularly in the management of IBD. There is no doubt that nurses already make a significant contribution, particularly to the provision of upper GI endoscopy, which frees consultant sessions for more technically difficult procedures such as colonoscopy and ERCP352