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العنوان
Adherence to Guidelines in Management of Irritable Bowel Syndrome in Ministry of Health Family Centers and Internal Medicine Department at Ain Shams University Hospitals /
المؤلف
El-Ezaby, Sarah Abdel Rahman Abdel Rahman.
هيئة الاعداد
باحث / Sarah Abdel Rahman Abdel Rahman El-Ezaby
مشرف / Essam Mohammed Bayoumy Helal
مشرف / Diaa Marzouk Abdel Hamid
مشرف / Mohamed Magdy Salama
تاريخ النشر
2017.
عدد الصفحات
137 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
ممارسة طب الأسرة
تاريخ الإجازة
1/1/2017
مكان الإجازة
جامعة عين شمس - كلية الطب - Family Medicine
الفهرس
Only 14 pages are availabe for public view

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Abstract

Irritable Bowel Syndrome (IBS) is a chronic functional disorder of gastrointestinal tract. It is characterized by abdominal pain or discomfort with abnormal bowel habit with the absence of biochemical or structural abnormalities, it is the commonest gastro-intestinal problem diagnosed in primary and secondary care and the most common reason for referral to gastroenterologists. It was reported that approximately 10-20% of adults in Western countries have IBS symptoms and a similar prevalence has been reported in Asia but prevalence in Africa is not clear.
Making a diagnosis of IBS is important because of the following reasons. Firstly, millions of patients without a definitive diagnosis have symptoms that are amenable to treatment, if the appropriate diagnosis is made. Secondly, untreated symptoms reduce productivity due to both presenteesim and absenteeism; proper treatment can improve the economic burden of this highly prevalent disorder. Thirdly, patients with symptoms of IBS have inappropriate fears and concerns about their symptoms and this may lead to unnecessary testing. Fourthly, lack of a diagnosis may lead to unnecessary procedures and surgeries.
Majority of patients with Irritable bowel syndrome are managed in primary health care facilities. Therefore it’s very important for general practitioners and family doctors to be well trained in the approach to functional gastrointestinal disorders
Objectives:
The study was conducted to measure the adherence to guideline in management of Irritable bowel syndrome at three of MOHP family health centers in Cairo, and Internal medicine department at Ain Shams University.
Subjects and methods:
A cross sectional study was carried out at Internal Medicine outpatient clinics at Ain shams University Hospitals and three of Family medicine centers: Saray el Quba, Al-Darrasa and the first settlement family centers, it was done among the doctors working in the clinics and every doctor was evaluated by two of his IBS patients.
Inclusion criteria:
1. The Physicians attending Internal Medicine outpatient clinic at Ain Shams university Hospitals during the study period
2. The physician attending family health centers outpatient clinics during the study period.
3. Patients who was diagnosed as Irritable Bowel Syndrome by the attending doctors in the outpatient clinics, every doctor evaluated by 2 patients.
Exclusion criteria:
Lecturers, assistant professors and professors at Ain Shams university Hospitals as they are not working in outpatient clinics
Sample size was 30 doctors and 60 patients from University Hospitals and also 30 doctors and 60 patients from the three Family health centers based on hypothesis to achieve 80% power to detect a difference between the group proportion of -0.3500, The proportion in group one (the family center group) is assumed to be 0.600 under Null hypothesis and 0.2500 under the alternative hypothesis. The proportion in group two (the internal medicine department group) is 0.6000.The Sample was collected along the period of 3 months from November 2016 till February 2017.
Data was collected through two tools:
1. A self- administered questionnaire to the doctors to measure the doctors’ knowledge and practice, the questionnaire was self-structured contained list of Rome III diagnostic criteria and list of NICE 2008 guidelines in management of IBS and the doctors marked on what they do in practice
2. An Interview Questionnaire to the patients diagnosed by participating doctors to evaluate the quality of doctors’ practice.
Data was analyzed using SPSS statistical package 20. Both descriptive and analytical tests were used.
Results:
60 doctors were recruited in the study. 30 from MOHP with mean age of MOHP was 36.7±10.4, (20%) were GPS, (73.3%) were family physicians and (6.66%) were internal medicine doctors. They were graduated earlier than and in university group was 27.7±2.1.
Regarding knowledge about IBS pathophysiology no difference between the two groups in their knowledge
As for approach to diagnose IBS, almost half of the participating physicians in each group relied on diagnostic criteria and patient history and physical examination.
By asking the patients it was found that (10%) of MOHP physicians were completely adherent to diagnostic criteria while (23.3%) of university physicians were completely adherent, they asked about symptoms and alarming signs, followed the criteria with the two patients and properly
As regards investigations, (80%) of patients in MOHP centers were not requested to do investigations while (60%) in university were not requested.
Regarding health education 68.3% of patients did not receive health education in MOHP centers and 70% in university also. Pharmacotherapy was prescribed by all physicians but psychotherapy didn’t requested.
It was found that the adherence was higher among doctors who had MSc degree, among internal medicine doctors and it was low among general practitioners.
Recommendations:
In Ain Shams university hospitals
1. The outpatient clinics are preferred to be attended by senior residents or assistant lecturers with the junior staff.
2. It’s preferred to control investigations requested by the doctors.
3. It’s important to give the doctors continuous education programs and keep them updated about the latest and international guidelines
In Family Health Centers:
1. Establish a good referral system to refer IBS cases who show alarming signs or need more investigations.
2. Enrolled the doctors in continuous education programs to improve their knowledge and keep them updated about the guidelines.
3. Continous auditing on doctors’ performance.
4. Give the doctors educational sessions about how to give health education, it’s importance as it’s the role of family doctors.
5. Consider referral to psychotherapist may help the patient to relieve the stress.