Alimentary tractThe management of common gastrointestinal disorders in general practice: A survey by the European Society for Primary Care Gastroenterology (ESPCG) in six European countries
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)
- et al.
Survey on colorectal cancer screening knowledge, attitudes and practices of general practice physicians in Lazio, Italy
Prev Med
(2005) - et al.
Morbidity, performance and quality in primary care. Dutch general practice on stage
(2006) - 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....
- 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) - et al.
Referral guidelines for colorectal cancer—do they work?
Ann R Coll Surg Engl
(2003) Improving the quality of care
JAMA
(2001)- et al.
Changing provider behaviour: An overview of systematic reviews of interventions
Med Care
(2001)