Maxine D Rouvroye, Pauline Slottje, Tom van Gils, Chris J Mulder, Jean W Muris, Dick Walstock, Marcel Reinders, Gerd Bouma
{"title":"全科医生诊断和治疗乳糜泻的洞察力:对106名全科医生的调查和病例研究。","authors":"Maxine D Rouvroye, Pauline Slottje, Tom van Gils, Chris J Mulder, Jean W Muris, Dick Walstock, Marcel Reinders, Gerd Bouma","doi":"10.1080/13814788.2021.1985455","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Coeliac disease (CD) is a highly prevalent (∼1%) disease that allegedly remains undiagnosed in over 80% of the cases because of atypical symptoms or silent disease. Currently, it is unknown how GPs deal with (suspected) CD.</p><p><strong>Objectives: </strong>This study aimed to better understand the diagnostic approach and the clinical reasoning process of GPs concerning CD and concurrently address diagnostic pitfalls.</p><p><strong>Methods: </strong>A questionnaire with case vignettes to assess the knowledge, diagnostic reasoning pattern and practice for CD by GPs was developed. It was sent through academic GP research networks (encompassing over 1500 GPs) in two large cities and to smaller practices in rural areas. The questionnaire was composed of seven background questions, 13 questions related to four case vignettes and six additional CD-related questions.</p><p><strong>Results: </strong>Responses were received from 106 GPs. Knowledge on risk factors for CD and appropriate testing of at-risk populations was limited. Twenty-two percent would diagnose CD in adults exclusively based on serology, without histopathological confirmation. In total, 99% would refer a newly diagnosed patient to a dietitian to initiate a gluten-free diet (GFD). In the absence of symptoms, only 33% would initiate a GFD.</p><p><strong>Conclusion: </strong>The results of this study have given us insight into the diagnostic process of GPs encountering patient with gluten-related complaints. Multiple serology test is available and used, while a positive serology test is not always followed up by a gastroduodenal biopsy to confirm the diagnosis. Most GPs would refer a symptomatic CD patient to a dietician for a GFD.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"313-319"},"PeriodicalIF":2.3000,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583831/pdf/","citationCount":"1","resultStr":"{\"title\":\"Insight in the diagnosis and treatment of coeliac disease in general practice: A survey and case vignette study among 106 general practitioners.\",\"authors\":\"Maxine D Rouvroye, Pauline Slottje, Tom van Gils, Chris J Mulder, Jean W Muris, Dick Walstock, Marcel Reinders, Gerd Bouma\",\"doi\":\"10.1080/13814788.2021.1985455\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Coeliac disease (CD) is a highly prevalent (∼1%) disease that allegedly remains undiagnosed in over 80% of the cases because of atypical symptoms or silent disease. Currently, it is unknown how GPs deal with (suspected) CD.</p><p><strong>Objectives: </strong>This study aimed to better understand the diagnostic approach and the clinical reasoning process of GPs concerning CD and concurrently address diagnostic pitfalls.</p><p><strong>Methods: </strong>A questionnaire with case vignettes to assess the knowledge, diagnostic reasoning pattern and practice for CD by GPs was developed. It was sent through academic GP research networks (encompassing over 1500 GPs) in two large cities and to smaller practices in rural areas. The questionnaire was composed of seven background questions, 13 questions related to four case vignettes and six additional CD-related questions.</p><p><strong>Results: </strong>Responses were received from 106 GPs. Knowledge on risk factors for CD and appropriate testing of at-risk populations was limited. Twenty-two percent would diagnose CD in adults exclusively based on serology, without histopathological confirmation. In total, 99% would refer a newly diagnosed patient to a dietitian to initiate a gluten-free diet (GFD). In the absence of symptoms, only 33% would initiate a GFD.</p><p><strong>Conclusion: </strong>The results of this study have given us insight into the diagnostic process of GPs encountering patient with gluten-related complaints. Multiple serology test is available and used, while a positive serology test is not always followed up by a gastroduodenal biopsy to confirm the diagnosis. Most GPs would refer a symptomatic CD patient to a dietician for a GFD.</p>\",\"PeriodicalId\":54380,\"journal\":{\"name\":\"European Journal of General Practice\",\"volume\":\"27 1\",\"pages\":\"313-319\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2021-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583831/pdf/\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of General Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/13814788.2021.1985455\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of General Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/13814788.2021.1985455","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Insight in the diagnosis and treatment of coeliac disease in general practice: A survey and case vignette study among 106 general practitioners.
Background: Coeliac disease (CD) is a highly prevalent (∼1%) disease that allegedly remains undiagnosed in over 80% of the cases because of atypical symptoms or silent disease. Currently, it is unknown how GPs deal with (suspected) CD.
Objectives: This study aimed to better understand the diagnostic approach and the clinical reasoning process of GPs concerning CD and concurrently address diagnostic pitfalls.
Methods: A questionnaire with case vignettes to assess the knowledge, diagnostic reasoning pattern and practice for CD by GPs was developed. It was sent through academic GP research networks (encompassing over 1500 GPs) in two large cities and to smaller practices in rural areas. The questionnaire was composed of seven background questions, 13 questions related to four case vignettes and six additional CD-related questions.
Results: Responses were received from 106 GPs. Knowledge on risk factors for CD and appropriate testing of at-risk populations was limited. Twenty-two percent would diagnose CD in adults exclusively based on serology, without histopathological confirmation. In total, 99% would refer a newly diagnosed patient to a dietitian to initiate a gluten-free diet (GFD). In the absence of symptoms, only 33% would initiate a GFD.
Conclusion: The results of this study have given us insight into the diagnostic process of GPs encountering patient with gluten-related complaints. Multiple serology test is available and used, while a positive serology test is not always followed up by a gastroduodenal biopsy to confirm the diagnosis. Most GPs would refer a symptomatic CD patient to a dietician for a GFD.
期刊介绍:
The EJGP aims to:
foster scientific research in primary care medicine (family medicine, general practice) in Europe
stimulate education and debate, relevant for the development of primary care medicine in Europe.
Scope
The EJGP publishes original research papers, review articles and clinical case reports on all aspects of primary care medicine (family medicine, general practice), providing new knowledge on medical decision-making, healthcare delivery, medical education, and research methodology.
Areas covered include primary care epidemiology, prevention, diagnosis, pharmacotherapy, non-drug interventions, multi- and comorbidity, palliative care, shared decision making, inter-professional collaboration, quality and safety, training and teaching, and quantitative and qualitative research methods.