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Referrals to a tertiary hospital: a window into clinical management issues in functional gastrointestinal disorders

Linedale, Ecushla C., Shazad, Muhammad A., Kellie, Andrew R., Mikocka-Walus, Antonina, Gibson, Peter R. and Andrews, Jane M. 2017, Referrals to a tertiary hospital: a window into clinical management issues in functional gastrointestinal disorders, Journal of Gastroenterology and Hepatology, vol. 1, no. 3, pp. 84-91, doi: 10.1002/jgh3.12015.

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Title Referrals to a tertiary hospital: a window into clinical management issues in functional gastrointestinal disorders
Author(s) Linedale, Ecushla C.
Shazad, Muhammad A.
Kellie, Andrew R.
Mikocka-Walus, AntoninaORCID iD for Mikocka-Walus, Antonina orcid.org/0000-0003-4864-3956
Gibson, Peter R.
Andrews, Jane M.
Journal name Journal of Gastroenterology and Hepatology
Volume number 1
Issue number 3
Start page 84
End page 91
Total pages 8
Publisher Wiley-Blackwell Publishing Asia
Place of publication Richmond, Vic.
Publication date 2017-11-20
ISSN 0815-9319
Keyword(s) functional gastrointestinal disorders
irritable bowel syndrome
management
primary care
tertiary care
Summary Background and Aim
To investigate the quality of and reasons for referrals of patients with likely functional gastrointestinal disorders (FGID) and explore patients’ experience of clinical management.

Methods
A cross sectional, mixed-methods study was undertaken. Referrals (July 2013–2015) to one gastroenterology outpatient department triaged as “likely FGID”, the referred patients and their referring primary healthcare providers were examined.

Results

A total of 69% of patients reported not yet receiving an initial diagnosis, 52% reported persistent/distressing symptoms or reduced quality of life, 24% feared missed or worsening pathology, and 35% were seeking repeat specialist consultation. Most patients were dissatisfied (40%) or only partially satisfied (36%) with current management. Dissatisfaction was significantly related to the lack of provision of a diagnosis and effective treatment options (P < 0.001). Referral quality was poor and with the reason for referral clearly communicated in only 25%. Common referral reasons included repeat presentations (n = 32), diagnostic uncertainty (n = 19), to ensure nothing is missed (n = 19), patient request (n = 17), no response to treatment (n = 16), and to allay patient fears (n = 14). A total of 28/60 primary healthcare providers were confident that their patient had a FGID, yet sought confirmation (n = 16), second opinion (n = 8), or advice (n = 4).

Conclusion
Current management of FGID in usual care is suboptimal, as evidenced by the tertiary referral load, patient dissatisfaction, and the lack of provision of diagnoses and effective treatment options. Some clinicians lack confidence in effectively identifying and managing these conditions. Resources and supports to equip and assist clinicians to identify and manage FGID successfully may enhance patient care.
Language eng
DOI 10.1002/jgh3.12015
Field of Research 110307 Gastroenterology and Hepatology
1103 Clinical Sciences
Socio Economic Objective 920105 Digestive System Disorders
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution non-commercial licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30103987

Document type: Journal Article
Collections: School of Psychology
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.