Healthcare utilisation of patients with cholecystolithiasis in primary care: a multipractice comparative analysis

Abstract

ObjectivesTo examine general practitioners’ (GP) management of cholecystolithiasis and to evaluate persisting abdominal complaints in the years after the diagnosis.DesignRetrospective analysis of registry data and a subset of individual medical records.SettingSeventeen primary care practices affiliated with the Radboudumc Practice Based Research Network in the Netherlands.Participants633 patients with cholecystolithiasis diagnosed between 2012 and 2016.Primary and secondary outcome measuresThe primary outcome of this study was the healthcare utilisation of patients with cholecystolithiasis diagnosed by the GP in terms of referrals to secondary care, laboratory diagnostics, prescribed medication and the prevalence of concomitant abdominal-related diagnoses in a time interval of 3 years before and 3 years after diagnosis of cholecystolithiasis. For secondary outcomes, electronic medical records were studied from seven practices to assess emergency department visits, operation rates and repeat visits for persistent abdominal symptoms. We compared the non-referred group with the referred group.ResultsIn 57% of patients, concomitant abdominal-related diagnoses were recorded besides the diagnosis cholecystolithiasis. In-depth analyses of 294 patients showed a referral rate of 79.3% (n=233); 62.9% (n=185) underwent cholecystectomy. After referral, 55.4% (129/233) returned to the GP for persistent abdominal symptoms. Patients returning after referral were more often treated for another abdominal-related diagnosis before cholecystolithiasis was recorded (51.9% vs 28.8%, p<0.001).ConclusionsThe majority of patients in general practice with gallstones are referred and undergo cholecystectomy. Patients with concomitant abdominal-related diagnoses are likely to return to their physician. GPs should inform patients about these outcomes to improve the shared decision-making process before gallbladder surgery.

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

“…14 Harvard Medical School, Boston, MA, USA. 15 Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital,…”

“…Still, other times, conditions may allow physicians hours or more before the treatment begins, giving patients time to learn about the potential alternatives and make an informed decision about the next medical steps. The surgical literature [13] has stressed the benefits of applying SDM in trauma and emergency surgery, including better clinical outcomes by enhancing the quality of patient's recovery [14], better managing the patient's expectations [15], and limiting surgical interventions when they are not necessary [16]. Benefits can also be gathered from the hospital's organization, as SDM provides better patient management and flow [17], stimulating patient-centric care [18] and leading to patient empowerment and co-production practices [19,20].…”

Tailoring diagnosis and treatment in symptomatic gallstone disease

“…The authors 20 recently undertook a primary care analysis to explore general practitioner (GP) management of patients with gallstones in order to assess concomitant gastrointestinal diagnoses for pain. This study showed that 360 of 633 included patients with gallstones (57 per cent) were also diagnosed with another gastrointestinal disorder in the years before and after the diagnosis of symptomatic gallstone disease.…”

“…Patients were most often referred to the emergency department, surgeon or gastroenterologist (47.2, 42.5, and 10.3 per cent respectively). Ultimately, 79 per cent of all referred patients underwent cholecystectomy 20 . After cholecystectomy, more than half of the patients (52 per cent) returned to the GP with persistent abdominal pain.…”

Features of Metabolite Changes in Disease Evolution in Cholecystolithiasis

“…In addition, the population is seriously aging [ 2 – 6 ]. In an increasingly obese population, cholecystolithiasis becomes a significant and growing health problem [ 7 ] and the cholecystolithiasis prevalence is rising [ 8 ]. However, cholecystolithiasis is an acute or chronic infection of the gallbladder [ 9 ].…”