Alimentary tract
The management of common gastrointestinal disorders in general practice: A survey by the European Society for Primary Care Gastroenterology (ESPCG) in six European countries

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Abstract

Background

Gastrointestinal (GI) disorders account for 10% of all consultations in primary care. Little is known about the management of GI disorders by general practitioners (GP) across different European countries.

Aim and methods

We undertook a postal survey of randomly selected samples of GPs in six European countries (UK, Holland, Spain, Greece, Poland, Czech Republic) to determine patterns of diagnosis, management and service use in GI disorders.

Results

We received 939 responses, response rate 32%. Over 80% of GPs were aware of at least three national guidelines for gastrointestinal disease. The availability of open access endoscopy ranged from 28% (Poland) to over 80% (Holland, Czech and UK). For uninvestigated dyspepsia the preferred first line management was proton pump inhibitor therapy (33–82%), Helicobacter pylori test and treat (19–47%), early endoscopy (5–32%), specialist referral (2–21%). Regarding irritable bowel syndrome, 23% of respondents were familiar with one or more diagnostic criteria, but between 7% (Netherlands) and 32% (Poland) would ask for a specialist opinion before making the diagnosis.

Conclusion

The wide variation between GPs both between and within countries partly reflects variations in health care systems but also differing levels of knowledge and awareness, factors which are relevant to educational and research policy.

Section snippets

Background

Digestive disorders account for about 10% of all consultations in European primary care [1] and have a major impact on both quality of life and health care resources. General practitioners face specific challenges in their management, for example in the cost effective treatment of dyspepsia and gastro-oesophageal reflux, the differential diagnosis of lower gastrointestinal (GI) symptoms and the need for early detection of GI cancer. Presenting problems can vary widely in their severity, from

The survey instrument

We used a self-completion 29-item questionnaire developed in English and piloted twice with GPs in the UK to ensure face validity and comprehensibility. The questionnaire was translated into the languages of the participating countries, and the translations were checked for accuracy by a qualified clinician from that country. The questionnaire collected demographic data about respondents, characteristics of their practice, the sources of information they used in the management of

Results

We received 948 responses from 3000 participants (response rate 31.6%, range 25–45%), of which 939 were usable (Table 1). Response rates were significantly higher in Netherlands and Czech Republic than in other four countries (p < 0.0001). Over half (56%) of respondents were male and the median age decile was 41–50 years. 464 (49%) worked in urban locations and 240 (26%) defined their location as purely rural. Practice size varied considerably between countries-nearly 80% of practices in Spain

Discussion

Although, there were many commonalities, this pan-European survey demonstrated substantial variations between general practitioners in awareness, access to resources and in their clinical management of gastrointestinal disorders. The common areas were the recognition of alarm symptoms, such as rectal bleeding, the relative lack of awareness and application of criteria for IBS and common agreement with the use of acid suppression, especially PPIs, for the first line management of dyspepsia.

There

Conclusion

The survey results suggest there is a wide variation in the primary care management of the main gastrointestinal diseases, both between and within countries in Europe. These findings reflect variations in health systems but also differing levels of knowledge and awareness. There is a potential for improvement in the primary care management of gastrointestinal disorders and in the earlier detection of cancer. We believe that this survey contributes to the discussion about future models of care

Conflict of interest

None.

Acknowledgement

The study was funded by the ESPCG.

References (16)

  • A. Federici et al.

    Survey on colorectal cancer screening knowledge, attitudes and practices of general practice physicians in Lazio, Italy

    Prev Med

    (2005)
  • G.P. Westert et al.

    Morbidity, performance and quality in primary care. Dutch general practice on stage

    (2006)
  • P. Katelaris et al.

    Gastro-oesophageal reflux disease in adults guidelines for clinicians

    J Gastroenterol Hepatol

    (2002)
  • Managing dyspepsia in adults in primary care, NICE guideline; 2004....
  • G. Rubin et al.

    The use of consensus to develop guidelines for the management of Helicobacter pylori infection in primary care. European Society for Primary Care Gastroenterology

    Fam Pract

    (2000 August)
  • A.J. Eccersley et al.

    Referral guidelines for colorectal cancer—do they work?

    Ann R Coll Surg Engl

    (2003)
  • R. Grol

    Improving the quality of care

    JAMA

    (2001)
  • J.M. Grimshaw et al.

    Changing provider behaviour: An overview of systematic reviews of interventions

    Med Care

    (2001)
There are more references available in the full text version of this article.

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