Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study.

Autor:	Taylor MA; The University of Sheffield Medical School, Sheffield, UK., Blanshard RJ; Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, Sheffield, UK.; The University of Sheffield, Sheffield, Sheffield, UK., Naylor G; Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, Derbyshire, UK., Penny HA; Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, Sheffield, UK., Mooney PD; Department of Gastroenterology, Northern General Hospital, Sheffield, Sheffield, UK.; Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK., Sanders DS; The University of Sheffield Medical School, Sheffield, UK david.sanders1@nhs.net.; Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, Sheffield, UK.
Jazyk:	angličtina
Zdroj:	BMJ open gastroenterology [BMJ Open Gastroenterol] 2021 Jan; Vol. 8 (1).
DOI:	10.1136/bmjgast-2020-000544
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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