BACKGROUND: Patients with undiagnosed inflammatory bowel disease (IBD) are often evaluated initially by primary care physicians (PCPs). Despite the frequency with which PCPs evaluate chronic abdominal pain and chronic diarrhea, little is known about how they approach these symptoms. OBJECTIVES: To determine the diagnostic practices and referral patterns of PCPs when confronting a patient with potential IBD. METHODS: We conducted a mail survey of PCPs practicing in Rhode Island. Clinical vignettes describing patients with chronic abdominal pain and chronic diarrhea were presented. Respondents were asked to indicate how they would evaluate these scenarios and when they would refer to a specialist. RESULTS: 432 PCPs were surveyed; 35.6% responded. Wide variation in PCPs' definitions of chronic abdominal pain and chronic diarrhea was found, with only 26% and 51% of physicians, respectively, defining these symptoms to be chronic per standard definitions. Laboratory testing was found to vary significantly with practice type (p < 0.01 for 2 patient groups). Patient age influenced the ordering of diagnostic imaging (p < 0.0001), while patient gender did not. CONCLUSIONS: There is significant variability among PCPs in the threshold after which common gastrointestinal symptoms become chronic as well as in their diagnostic evaluation of these symptoms. This variability may lead to a lag in the diagnosis of IBD and influence patient outcomes.
BACKGROUND:Patients with undiagnosed inflammatory bowel disease (IBD) are often evaluated initially by primary care physicians (PCPs). Despite the frequency with which PCPs evaluate chronic abdominal pain and chronic diarrhea, little is known about how they approach these symptoms. OBJECTIVES: To determine the diagnostic practices and referral patterns of PCPs when confronting a patient with potential IBD. METHODS: We conducted a mail survey of PCPs practicing in Rhode Island. Clinical vignettes describing patients with chronic abdominal pain and chronic diarrhea were presented. Respondents were asked to indicate how they would evaluate these scenarios and when they would refer to a specialist. RESULTS: 432 PCPs were surveyed; 35.6% responded. Wide variation in PCPs' definitions of chronic abdominal pain and chronic diarrhea was found, with only 26% and 51% of physicians, respectively, defining these symptoms to be chronic per standard definitions. Laboratory testing was found to vary significantly with practice type (p < 0.01 for 2 patient groups). Patient age influenced the ordering of diagnostic imaging (p < 0.0001), while patient gender did not. CONCLUSIONS: There is significant variability among PCPs in the threshold after which common gastrointestinal symptoms become chronic as well as in their diagnostic evaluation of these symptoms. This variability may lead to a lag in the diagnosis of IBD and influence patient outcomes.
Authors: S Greenfield; E C Nelson; M Zubkoff; W Manning; W Rogers; R L Kravitz; A Keller; A R Tarlov; J E Ware Journal: JAMA Date: 1992-03-25 Impact factor: 56.272
Authors: Mark W Russo; Jeffrey T Wei; Michelle T Thiny; Lisa M Gangarosa; Alphonso Brown; Yehuda Ringel; Nicholas J Shaheen; Robert S Sandler Journal: Gastroenterology Date: 2004-05 Impact factor: 22.682
Authors: Jason M Shapiro; Helga Zoega; Samir A Shah; Renee M Bright; Meaghan Mallette; Heather Moniz; Stacey A Grabert; Barbara Bancroft; Marjorie Merrick; Nicole T Flowers; Zahid Samad; Sheldon Lidofsky; Neal S LeLeiko; Bruce E Sands Journal: Inflamm Bowel Dis Date: 2016-06 Impact factor: 5.325