GP perspectives of irritable bowel syndrome – an accepted illness, but management deviates from guidelines: a qualitative study

BMC Family Practice

Research Article

Val Harrington¹  David G Thompson²  Paula Beech²  Sarah J O’Brien³  Elaine F Harkness⁴  Sue Hinder⁵  Carolyn A Chew-Graham⁶ 

[1] Centre for the History of Science Technology & Medicine, Simon Building, University of Manchester, Oxford Road, M13 9PL, Manchester, England;Gastrointestinal Centre, Institute of Inflammation & Repair, Clinical Sciences Building, Salford Royal NHS Foundation Trust, University of Manchester, Stott Lane, M6 8HD, Salford, England;Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Chester High Road, CH64 7TE, Neston, South Wirral, England;Institute of Inflammation and Repair, Stopford Building, University of Manchester, Oxford Road, M13 9PL, Manchester, England;RaFT Research and Consulting-Asking the Right Questions, Lower Hall, Downham, BB7 4BN, Clitheroe, Lancashire, England;Research Institute, Primary Care and Health Sciences, Keele University, ST5 5BG, Keele, Staffordshire, England;

关键词: Irritable Bowel Syndrome;    Functional Gastrointestinal Disorders;    Medically Unexplained Symptoms;    NICE Guideline;    Primary Care;    General Practitioners;   

DOI  :  10.1186/1471-2296-14-92

 received in 2013-02-20, accepted in 2013-06-20,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe estimated prevalence of irritable bowel syndrome (IBS) is 10%. Up to one third of patients develop chronic symptoms, which impact on everyday functioning and psychological wellbeing. Guidelines suggest an increased role for primary care in the management of patients with IBS, and referral for psychological interventions. Literature reports dissatisfaction and frustration experienced by both patients with IBS and healthcare professionals. The aim of this study was to explore the perspectives of general practitioners (GPs) in relation to the diagnosis and management of IBS and their views on the potential use of a risk assessment tool to aid management decisions for patients with IBS in primary care.MethodsThis was a qualitative study using face-to-face semi-structured interviews with GPs in North West England. Interviews were fully transcribed and data analyzed using constant comparison across interviews. Tensions between GP accounts and the NICE guideline for the management of IBS were highlighted.ResultsGPs described IBS as a diagnosis of exclusion and the process as tentative and iterative, with delay in adding a Read code to the patient record until they were confident of the diagnosis. Whilst GPs accepted there was a link between IBS and psychological symptoms they suggested that the majority of patients could be managed within primary care without referral for psychological interventions, in conflict with the NICE guideline. They did not feel that a risk assessment tool for patients with IBS would be helpful.ConclusionsThis study highlights the tensions between evidence recognizing the need to identify patients whose symptoms may become chronic and offer pro-active care, including referral for psychological therapies, and the perspectives of GPs managing patients in every-day clinical practice. The reluctance of GPs to refer patients for evidence-based psychological treatments may have implications for commissioning services and patient care.

【 授权许可】

CC BY   
© Harkness et al.; licensee BioMed Central Ltd. 2013