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Open Access Research article

GP perspectives of irritable bowel syndrome – an accepted illness, but management deviates from guidelines: a qualitative study

Elaine F Harkness1*, Val Harrington2, Sue Hinder3, Sarah J O’Brien4, David G Thompson5, Paula Beech5 and Carolyn A Chew-Graham6

Author Affiliations

1 Institute of Inflammation and Repair, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PL, England

2 Centre for the History of Science Technology & Medicine, Simon Building, University of Manchester, Oxford Road, Manchester M13 9PL, England

3 RaFT Research and Consulting-Asking the Right Questions, Lower Hall, Downham, Clitheroe, Lancashire BB7 4BN, England

4 Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Chester High Road, Neston, South Wirral CH64 7TE, England

5 Gastrointestinal Centre, Institute of Inflammation & Repair, University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, England

6 Research Institute, Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, England

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BMC Family Practice 2013, 14:92  doi:10.1186/1471-2296-14-92

Published: 27 June 2013

Abstract

Background

The estimated prevalence of irritable bowel syndrome (IBS) is 10%. Up to one third of patients develop chronic symptoms, which impact on everyday functioning and psychological wellbeing. Guidelines suggest an increased role for primary care in the management of patients with IBS, and referral for psychological interventions. Literature reports dissatisfaction and frustration experienced by both patients with IBS and healthcare professionals. The aim of this study was to explore the perspectives of general practitioners (GPs) in relation to the diagnosis and management of IBS and their views on the potential use of a risk assessment tool to aid management decisions for patients with IBS in primary care.

Methods

This was a qualitative study using face-to-face semi-structured interviews with GPs in North West England. Interviews were fully transcribed and data analyzed using constant comparison across interviews. Tensions between GP accounts and the NICE guideline for the management of IBS were highlighted.

Results

GPs described IBS as a diagnosis of exclusion and the process as tentative and iterative, with delay in adding a Read code to the patient record until they were confident of the diagnosis. Whilst GPs accepted there was a link between IBS and psychological symptoms they suggested that the majority of patients could be managed within primary care without referral for psychological interventions, in conflict with the NICE guideline. They did not feel that a risk assessment tool for patients with IBS would be helpful.

Conclusions

This study highlights the tensions between evidence recognizing the need to identify patients whose symptoms may become chronic and offer pro-active care, including referral for psychological therapies, and the perspectives of GPs managing patients in every-day clinical practice. The reluctance of GPs to refer patients for evidence-based psychological treatments may have implications for commissioning services and patient care.

Keywords:
Irritable Bowel Syndrome; Functional Gastrointestinal Disorders; Medically Unexplained Symptoms; NICE Guideline; Primary Care; General Practitioners