Table A.3 Developments in service delivery: summary of articles examined for secondary services
| ID and authors | Research setting and year of study | Study design | Sample size | Topic of document | Key results and conclusions | Level of evidence | Quality score (AGREE) (%) |
|---|---|---|---|---|---|---|---|
| Provenzale et al704 | International (1980–98) | Literature review | 2157 Articles; 10 included | Specialised and general GI care | Gastroenterologists may provide better care than other provider types for certain disorders | 1 | 80 |
| Williams et al491 | UK (2001–04) | RCT and cost effectiveness study | 1800 | Nurse endoscopy | Nurses are clinically as effective as doctors but preferred by patients | 1 | |
| Delaney et al724 | UK (1995–98) | RCT | 442 Patients | Cost effectiveness of endoscopy for patients over 50 | Initial endoscopy in dyspeptic patients over 50 years of age might be a cost effective intervention | 2+ | 77 |
| CRD560 | UK (2004) | Commentary; review of evidence | Around 190 articles | Management of colorectal cancers | Nurse 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 studies | 2+ | 59 |
| Pathmakanthan et al711 | UK (2000) | Survey of clinicians | 176 Responses | Nurse endoscopists in the UK | Nurse 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 capacity | 2− | 70 |
| Aly et al705 | UK (1999) | Survey of clinicians | 538 Responses | Non-compliance with guidelines | It 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 introduction | 2− | 66 |
| Smale et al712 | UK (2000–01) | Analysis of routine data; survey | 3489 Patients | Upper GI endoscopy performed by nurses | Experienced nurses perform routine diagnostic gastroscopy safely in everyday clinical practice and with as little discomfort and as much patient satisfaction as medical staff | 2− | 66 |
| Quirk et al707 | USA (1994–95) | Retrospective study; analysis of routine data | 124 Patients | Physician specialty | Patients 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 surgeons | 2− | 64 |
| Bohra et al706 | Dublin, UK (2000) | Analysis of routine data | 242 Cases | Analysis of GI services | We 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-up | 2− | 57 |
| McKinlay et al713 | UK (2003) | Expert commentary and recommendations; survey of clinicians | 28 GI units; 67 GI consultants | Modernisation of the gastroenterology service in Scotland | A 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 ERCP | 3 | 52 |