Patients with functional gastrointestinal disorders spend less time in tertiary care when managed by a single clinician: results of a multicentre audit in South Australia

Background and Aims

Functional gastrointestinal disorders (FGIDs) impact quality of life and represent a significant burden on healthcare services. Guidelines recommend an early, positive diagnosis to reduce harmful over-investigation in FGID patients. The aim of this multicentre study was to evaluate FGID management against current guidelines.

Methods

A multicentre, retrospective evaluation of patients with a primary diagnosis of FGID across two tertiary gastroenterology services over a 12-month period was performed. Time to diagnosis of a FGID, number of outpatient encounters, number and type of investigations performed and time to discharge from the outpatient service were assessed. Whether care was delivered by single or multiple clinicians was recorded. Statistical analysis was performed using Student's t test, logistic regression analysis and Kaplan–Meir curves.

Results

Between June 2021 and June 2022, 275 individual patients were reviewed primarily for FGID. Median time to FGID diagnosis was 70 days (interquartile range (IQR): 0–175), over a median of four outpatient encounters (IQR: 3–6), with an overall time in service of 182 days (IQR: 105–344). When care was delivered by a single rather than multiple clinicians, patients were more likely to receive a FGID diagnosis early (hazard ratio (HR): 1.6, 95% confidence interval (CI): 1.25–2.04, P < 0.0001), be discharged sooner (HR: 1.83, 95% CI: 1.44–2.33, P < 0.0001), with a trend towards less harmful investigations (odds ratio: 1.79, 95% CI: 0.96–3.58, P = 0.08).

Conclusions

Consistent delivery of clinical care reduces healthcare utilisation in the management of FGIDs. Further studies are needed to identify optimal care models for managing outpatients with FGIDs.