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

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.

A survey of the practice of stroke doctors in developing transient ischaemic attack services in the UK.

RATIONALE, AIMS AND OBJECTIVES: (1) To describe current practice in the establishment and running of transient ischaemic attack (TIA) clinics in the UK; (2) to identify whether TIA targets are met; (3) to inform future TIA service development. METHODS: A survey distributed to the members of the British Association of Stroke Physicians (BASP). RESULTS: Forty-one per cent of full BASP members responded to the survey. TIA clinics were being run by 77% of respondents. Of the remainder 75% had plans to do so. Dedicated consultant time for stroke predominated among those involved in clinics (87% vs. 54%). The median time for clinics operation was 36 months. The median time from TIA to appointment was 2 weeks, exceeding national targets. Sixty-four per cent of clinics were run weekly and 31% more than once a week. Forty-six per cent stated they ran a one-stop clinic service yet only 10% said there were no later follow-up visits. A patient returning for completion of investigations was the most common reason for this (60%). Waits for investigations were reported - 53% indicated a wait for carotid Doppler scanning and 41% indicated this wait was in excess of 1 week. CONCLUSION: Key areas of concern arising from this survey were that time from TIA to clinic appointment remained outside the national target and there were delays for key investigations. Current service models are inadequate to meet current TIA targets and exploration of alternative service models is required.

An overview of transient ischaemic attack.

This article provides an overview of transient ischaemic attack (TIA). It discusses the clinical presentation of TIA, its significance as a marker of vascular risk, key diagnostic interventions and management strategies. Trends and challenges in service provision and the roles of specialist and general nurses in managing patients with TIA are explored.