Stool submission by general practitioners in SW England - when, why and how? A qualitative study

Abstract

BackgroundWe know little about when and why general practitioners (GPs) submit stool specimens in patients with diarrhoea. The recent UK-wide intestinal infectious disease (IID2) study found ten GP consultations for every case reported to national surveillance. We aimed to explore what factors influence GP’s decisions to send stool specimens for laboratory investigation, and what guidance, if any, informs them.MethodsWe used qualitative methods that enabled us to explore opinions and ask open questions through 20 telephone interviews with GPs with a range of stool submission rates in England, and a discussion group with 24 GPs. Interviews were transcribed and subjected to content analysis.ResultsInterviews: GPs only sent stool specimens to microbiology if diarrhoea persisted for over one week, after recent travel, or the patient was very unwell. Very few had a systematic approach to determine the clinical or public health need for a stool specimen. Only two GPs specifically asked patients about blood in their stool; only half asked about recent antibiotics, or potential food poisoning, and few asked about patients’ occupations. Few GPs gave patients advice on how to collect specimens.Results from interviews and discussion group in relation to guidance: All reported that the HPA stool guidance and patient collection instructions would be useful in their clinical work, but only one GP (an interviewee) had previously accessed them. The majority of GPs would value links to guidance on electronic requests. Most GPs were surprised that a negative stool report did not exclude all the common causes of IID.ConclusionsGPs value stool culture and laboratories should continue to provide it. Patient instructions on how to collect stool specimens should be within stool collection kits. Through readily accessible guidance and education, GPs need to be encouraged to develop a more systematic approach to eliciting and recording details in the patient’s history that indicate greater risk of severe infection or public health consequences. Mild or short duration IID (under one week) due to any cause is less likely to be picked up in national surveillance as GPs do not routinely submit specimens in these cases.

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

“…The determinants for requesting a faecal specimen, as found by this study, are similar to those found in other studies [28, 30–32, 34–36] and are consistent with published recommendations on the clinical management of AG cases [4, 37]. Additionally, our study showed that factors related to the health system (e.g.…”

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

“…Overall response rate within the questionnaire was excellent, as over 94% answered each question bar one where there was a typographical error. The present findings echo the findings of a previous qualitative study, 2 but in a generalisable group of GPs. This survey is reported behaviour and is open to acquiescence bias, and cannot replace a case-based audit or prospective study of clinical cases of diarrhoea; however, such a study would be much more time-consuming.…”

“…2 This reported behaviour has been backed up by data from a longitudinal study of infectious intestinal disease (IID) in the UK, which showed that there were 147 community cases of IID and 10 GP consultations for every case reported to national surveillance. 3 In the current study, limited but rich qualitative data were used from the previous study, 2 to develop a questionnaire to collect data from a much larger sample of GPs.…”

“…2 This reported behaviour has been backed up by data from a longitudinal study of infectious intestinal disease (IID) in the UK, which showed that there were 147 community cases of IID and 10 GP consultations for every case reported to national surveillance. 3 In the current study, limited but rich qualitative data were used from the previous study, 2 to develop a questionnaire to collect data from a much larger sample of GPs. The aim was to determine what clinical and public health criteria GPs use to decide when to send stool specimens, what (including national guidance) informs these management decisions, whether GPs would prescribe an antibiotic before they receive a stool culture result, and to elicit how practice related to national guidance.…”

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

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