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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Autores principales:	Hugo A Penny, Matthew A Taylor, Rebecca J Blanshard, Gregory Naylor, Peter D Mooney
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/f4b64d6f22cb497d96d73685cc53dfd5
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spelling	oai:doaj.org-article:f4b64d6f22cb497d96d73685cc53dfd52021-11-21T11:30:06ZDo gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study10.1136/bmjgast-2020-0005442054-4774https://doaj.org/article/f4b64d6f22cb497d96d73685cc53dfd52021-11-01T00:00:00Zhttps://bmjopengastro.bmj.com/content/8/1/e000544.fullhttps://doaj.org/toc/2054-4774Objective 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.Hugo A PennyMatthew A TaylorRebecca J BlanshardGregory NaylorPeter D MooneyBMJ Publishing GrouparticleDiseases of the digestive system. GastroenterologyRC799-869ENBMJ Open Gastroenterology, Vol 8, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 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
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
author	Hugo A Penny Matthew A Taylor Rebecca J Blanshard Gregory Naylor Peter D Mooney
author_facet	Hugo A Penny Matthew A Taylor Rebecca J Blanshard Gregory Naylor Peter D Mooney
author_sort	Hugo A Penny
title	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_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_sort	do gastroenterologists have medical inertia towards coeliac disease? a uk multicentre secondary care study
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/f4b64d6f22cb497d96d73685cc53dfd5
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Do gastroenterologists have medical inertia towards coeliac disease? A UK multicentre secondary care study

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