Rurality: A crucial determinant in the provision of colonoscopy in the Northern Territory's Top End

Background and Aim: Colorectal cancer is the third most commonly diagnosed cancer in Australia. Australians living in rural and remote areas generally have poorer access to health services than those in metropolitan areas. We aimed to determine if rurality affected the provision of colonoscopy in the Top End Health Service (TEHS).
Methods: All episodes of colonoscopy performed in the TEHS from 2017 to 2021 were identified. Suburbs and localities of each patient were categorized based on the Modified Monash Model (MMM) of rurality, for which TEHS has categories 2, 5, 6, and 7. Rates of colonoscopies (per 1000 people) were calculated against the population estimates derived from the 2016 Australian Census for each category of MMM. We used χ2 and Fisher’s exact tests to determine whether the rates of colonoscopy differed significantly between each category of MMM.
Results: A total of 9629 episodes of colonoscopy of 6128 unique patients were identified from 2017 to 2021. Colonoscopy was performed in the following four hospitals: Royal Darwin Hospital (MMM, 2), Palmerston Regional Hospital (MMM, 2), Katherine Hospital (MMM, 6), and Gove District Hospital (MMM, 7). The percentages of colonoscopies performed at each hospital were 36%, 53%, 6%, and 5%, respectively. Overall, χ2 statistics suggested a significant difference in rates of colonoscopy be-tween each category of the MMM (P < 0.001) (Table 1). This observation was significant in the remote (MMM, 6) and very remote (MMM,7) communities compared with regional centers (MMM, 2) and remained relatively unchanged over the 5-year period. However, there was an increase in colonoscopy rates for people who lived in small rural towns (MMM, 5), likely attributable to the increase in colonoscopy capacity in our regional hospital (Palmerston Regional Hospital), which is about 3 h away.
Conclusion: Our study showed ongoing health care inequities in regard to access to colonoscopy, especially in remote and very remote communities of the Northern Territory. Strategies will be needed to address this.