Management of suspected infectious diarrhoea by English GPs: are they right?

McNulty, C.; Lasseter, Gemma; Verlander, Neville Q.; Yoxall, Harry; Moore, Philippa; O’Brien, Sarah J.; Evans, Mark

doi:10.3399/bjgp14x676429

Cited by 9 publications

(7 citation statements)

References 14 publications

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“…The GPs’ self-estimated proportion of requesting faecal specimens for 18% of patients is comparable to other studies where rates vary between 4.3% and 50% [ 25 , 28 , 31 – 33 ]. Individual rates differed strongly among the GPs interviewed.…”

Section: Discussionsupporting

confidence: 81%

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Acute Gastroenteritis and Campylobacteriosis in Swiss Primary Care: The Viewpoint of General Practitioners

et al. 2016

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Acute gastroenteritis (AG) is frequently caused by infectious intestinal diseases (IID) including food- and waterborne pathogens of public health importance. Among these pathogens, Campylobacter spp. plays a major role. Many European countries monitor selected IIDs within disease surveillance systems. In Switzerland, the information on IIDs is restricted to limited surveillance data, while no data is available for AG. We conducted a qualitative study among Swiss general practitioners (GPs) to investigate the case management of AG and campylobacteriosis patients, the associated disease burden and the determinants leading to registration in the National Notification System for Infectious Diseases (NNSID). Interviews were conducted with a semi-structured questionnaire and underwent inductive content analysis based on Grounded Theory. The questionnaire was repeatedly adapted to capture emerging themes until the point of theoretical saturation. GPs perceived AG and campylobacteriosis of little relevance to their daily work and public health in general. According to GP self-estimates each consults about two cases of AG per week and diagnoses a median of five campylobacteriosis cases per year. A large proportion of AG cases receives telephone consultations only and gets medical advice from the practice nurse. Antibiotic therapy is considered useful and stool diagnostics are performed for about a fifth of consulting AG patients. Stool diagnostics (“test”) and antibiotic therapy (“treat”) are interrelated and follow four strategies: “Wait & See”, “Treat & See”, “Treat & Test”, and “Test & See”. AG case management is diverse and includes different triage steps. A small proportion of AG patients have stool diagnostics performed and only positive tested patients are reported to the NNSID. As a result severe cases and cases with a history of travel abroad are overrepresented in the NNSID. The use of multiplex PCR panels in routine diagnostics likely leads to improved case management and higher case numbers in surveillance systems.

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Section: Discussionsupporting

confidence: 81%

“…Individual rates differed strongly among the GPs interviewed. The observed heterogeneity seems to be rather common and has also been observed among English GPs [ 31 ]. It is likely related to GPs’ individually perceived usefulness of stool diagnostic results for case management and the patient populations they serve.…”

Section: Discussionmentioning

confidence: 77%

Acute Gastroenteritis and Campylobacteriosis in Swiss Primary Care: The Viewpoint of General Practitioners

et al. 2016

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“…The King’s Fund recently reported that practices performing well on delivering a good experience for their patients also perform well on measures of clinical quality. 20 In a recent English survey, 89% of GP responders ( n = 477) 21 reported giving verbal advice to patients on how to collect a stool specimen although only 2% gave written instructions; 22 this is despite the fact that it has been shown that screening compliance is significantly improved when patients have an information leaflet. 23 …”

Section: Discussionmentioning

confidence: 99%

Patients’ perspectives on providing a stool sample to their GP: a qualitative study

2014

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BackgroundStool specimen collection is challenging and informal feedback has indicated that participants find the process difficult. Increasing stool specimen returns would improve the investigation of outbreaks of diarrhoeal and food-borne disease.AimTo explore the barriers to stool sample collection and specimen return to ascertain which factors may help to improve the process.Design and settingQualitative patient interview study in Gloucester, UK.MethodA two-stage purposive sampling process was used to identify patients who had either previous experience or no experience of collecting a stool sample. The interview schedule, based on the theory of planned behaviour, was used to facilitate interviews with 26 patients. Interview transcripts were analysed using a modified framework analysis.ResultsBarriers to collection included embarrassment, fear of results, concerns around hygiene and contamination, discretion and privacy, and lack of information. Personal gain was identified as the main incentive to collecting and returning a stool sample. The need for an information leaflet on stool collection was emphasised by most patients.ConclusionsGPs could make a number of small changes that could make a big difference for patients and potentially increase stool sample return. If they, rather than receptionists, distributed collection kits it may be easier for patients to ask any questions they had regarding collection. In addition, the provision of a stool-collection information leaflet could increase patients’ confidence regarding collecting the sample, and providing drop-off boxes for specimens could help prevent patients’ embarrassment regarding handing their stool over to a receptionist.

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“…However, comparing international rates is hampered by disparities in case definitions, study designs, periods of recall of symptoms and the characteristics of the populations studied [ 10 , 11 ]. Most people with IID do not seek medical attention [ 2 , 4 ], and even when they do their illness is often not investigated or reported [ 12 ], so it is difficult to determine accurately the population incidence of disease based on national surveillance or other routinely collected data.…”

Section: Introductionmentioning

confidence: 99%

Estimating the Incidence of Acute Infectious Intestinal Disease in the Community in the UK: A Retrospective Telephone Survey

Viviani

Irvine

et al. 2016

PLoS ONE

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ObjectivesTo estimate the burden of intestinal infectious disease (IID) in the UK and determine whether disease burden estimations using a retrospective study design differ from those using a prospective study design.Design/SettingA retrospective telephone survey undertaken in each of the four countries comprising the United Kingdom. Participants were randomly asked about illness either in the past 7 or 28 days.Participants14,813 individuals for all of whom we had a legible recording of their agreement to participateOutcomesSelf-reported IID, defined as loose stools or clinically significant vomiting lasting less than two weeks, in the absence of a known non-infectious cause.ResultsThe rate of self-reported IID varied substantially depending on whether asked for illness in the previous 7 or 28 days. After standardising for age and sex, and adjusting for the number of interviews completed each month and the relative size of each UK country, the estimated rate of IID in the 7-day recall group was 1,530 cases per 1,000 person-years (95% CI: 1135–2113), while in the 28-day recall group it was 533 cases per 1,000 person-years (95% CI: 377–778). There was no significant variation in rates between the four countries. Rates in this study were also higher than in a related prospective study undertaken at the same time.ConclusionsThe estimated burden of disease from IID varied dramatically depending on study design. Retrospective studies of IID give higher estimates of disease burden than prospective studies. Of retrospective studies longer recall periods give lower estimated rates than studies with short recall periods. Caution needs to be exercised when comparing studies of self-reported IID as small changes in study design or case definition can markedly affect estimated rates.

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Management of suspected infectious diarrhoea by English GPs: are they right?

Abstract: Background

Cited by 9 publications

References 14 publications

Acute Gastroenteritis and Campylobacteriosis in Swiss Primary Care: The Viewpoint of General Practitioners

Acute Gastroenteritis and Campylobacteriosis in Swiss Primary Care: The Viewpoint of General Practitioners

Patients’ perspectives on providing a stool sample to their GP: a qualitative study

Estimating the Incidence of Acute Infectious Intestinal Disease in the Community in the UK: A Retrospective Telephone Survey

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