Colorectal cancer

: a comparative study of models of health care delivery in two adjacent trusts in South Wales

Abstract

Introduction Survival in colorectal cancer patients is dependant on the stage of the cancer at diagnosis. Referral via an appropriate pathway to a specialist service is vital to the early detection of colorectal cancer but there is neither a standard referral system nor a nationally agreed referral pathway in the UK. Though studies have compared individual components of different models of health care in colorectal cancer, this is the first study comparing two models in their entirety. Hypothesis The distinct model of service delivery in Trust A picks up a higher percentage of early colorectal cancers than the model of service delivery in Trust B. Method The study compares colorectal cancers diagnosed from two adjacent Trusts in Wales during a three year period. The samples obtained after rigid exclusions correlate the two models of health care with the stage of cancer at diagnosis. Results Trust A has a higher emergency and urgent workload. The overall pick up of early cancers is similar in both Trusts. However, there is a higher pick up rate of early colorectal cancer in Trust A, when GPs accessed the specialist service using an urgent referral through the elective route. Trust A had lower overall waiting times for the first clinic appointment but there was no difference for urgent cases between the two Trusts. Specialists in Trust B had a higher rate of re-prioritisation of urgent GP referrals to the non urgent category. Conclusion There appears to be no significant difference in the overall pick-up rate of modified Dukes’ A colorectal cancers between the two models of health care delivery. The higher pick up rate of early colorectal cancer in Trust A was achieved only where GPs sent patients into the specialist service using an urgent referral through the elective route.

Date of Award	2009
Original language	English