Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study
Objective This study aimed to assess if there is secondary care medical inertia towards coeliac disease (CD).Design Group (1): Time from primary care presentation to diagnostic endoscopy was quantified in 151 adult patients with a positive endomysial antibody test and compared with 92 adult patients...
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BMJ Publishing Group
2021-10-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/8/1/e000544.full |
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| author | David S Sanders Hugo A Penny Matthew A Taylor Rebecca J Blanshard Gregory Naylor Peter D Mooney |
| author_facet | David S Sanders Hugo A Penny Matthew A Taylor Rebecca J Blanshard Gregory Naylor Peter D Mooney |
| author_sort | David S Sanders |
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| description | Objective This study aimed to assess if there is secondary care medical inertia towards coeliac disease (CD).Design Group (1): Time from primary care presentation to diagnostic endoscopy was quantified in 151 adult patients with a positive endomysial antibody test and compared with 92 adult patients with histologically proven inflammatory bowel disease (IBD). Group (2): Across four hospitals, duodenal biopsy reports for suspected CD were reviewed (n=1423). Group (3): Clinical complexity was compared between known CD (n=102) and IBD (n=99) patients at their respective follow-up clinic appointments. Group (4): 50 gastroenterologists were questioned about their perspective on CD and IBD.Results Group (1): Suspected coeliac patients waited significantly longer for diagnostic endoscopy following referral (48.5 (28–89) days) than suspected patients with IBD (34.5 (18–70) days; p=0.003). Group (2): 1423 patients underwent diagnostic endoscopy for possible CD, with only 40.0% meeting guidelines to take four biopsies. Increased diagnosis of CD occurred if guidelines were followed (10.1% vs 4.6% p<0.0001). 12.4% of newly diagnosed CD patients had at least one non-diagnostic gastroscopy in the 5 years prior to diagnosis. Group (4): 32.0% of gastroenterologists failed to identify that CD has greater prevalence in adults than IBD. Moreover, 36.0% of gastroenterologists felt that doctors were not required for the management of CD.Conclusion Prolonged waiting times for endoscopy and inadequacies in biopsy technique were demonstrated suggesting medical inertia towards CD. However, this has to be balanced against rationalising care accordingly. A Coeliac UK National Patient Charter may standardise care across the UK. |
| format | Article |
| id | doaj-art-f4b64d6f22cb497d96d73685cc53dfd5 |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-f4b64d6f22cb497d96d73685cc53dfd52024-12-07T08:55:11ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742021-10-018110.1136/bmjgast-2020-000544Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care studyDavid S Sanders0Hugo A Penny1Matthew A Taylor2Rebecca J Blanshard3Gregory Naylor4Peter D Mooney5Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UKAcademic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UKThe University of Sheffield Medical School, Sheffield, UKAcademic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, Sheffield, UKGastrointestinal Cancers, Beatson West of Scotland Cancer Centre, Glasgow, UKDepartment of Gastroenterology, Northern General Hospital, Sheffield, Sheffield, UKObjective This study aimed to assess if there is secondary care medical inertia towards coeliac disease (CD).Design Group (1): Time from primary care presentation to diagnostic endoscopy was quantified in 151 adult patients with a positive endomysial antibody test and compared with 92 adult patients with histologically proven inflammatory bowel disease (IBD). Group (2): Across four hospitals, duodenal biopsy reports for suspected CD were reviewed (n=1423). Group (3): Clinical complexity was compared between known CD (n=102) and IBD (n=99) patients at their respective follow-up clinic appointments. Group (4): 50 gastroenterologists were questioned about their perspective on CD and IBD.Results Group (1): Suspected coeliac patients waited significantly longer for diagnostic endoscopy following referral (48.5 (28–89) days) than suspected patients with IBD (34.5 (18–70) days; p=0.003). Group (2): 1423 patients underwent diagnostic endoscopy for possible CD, with only 40.0% meeting guidelines to take four biopsies. Increased diagnosis of CD occurred if guidelines were followed (10.1% vs 4.6% p<0.0001). 12.4% of newly diagnosed CD patients had at least one non-diagnostic gastroscopy in the 5 years prior to diagnosis. Group (4): 32.0% of gastroenterologists failed to identify that CD has greater prevalence in adults than IBD. Moreover, 36.0% of gastroenterologists felt that doctors were not required for the management of CD.Conclusion Prolonged waiting times for endoscopy and inadequacies in biopsy technique were demonstrated suggesting medical inertia towards CD. However, this has to be balanced against rationalising care accordingly. A Coeliac UK National Patient Charter may standardise care across the UK.https://bmjopengastro.bmj.com/content/8/1/e000544.full |
| spellingShingle | David S Sanders Hugo A Penny Matthew A Taylor Rebecca J Blanshard Gregory Naylor Peter D Mooney Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study BMJ Open Gastroenterology |
| title | Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study |
| title_full | Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study |
| title_fullStr | Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study |
| title_full_unstemmed | Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study |
| title_short | Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study |
| title_sort | do gastroenterologists have medical inertia towards coeliac disease a uk multicentre secondary care study |
| url | https://bmjopengastro.bmj.com/content/8/1/e000544.full |
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