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Stool submission by general practitioners in SW England - when, why, and how? a qualitative study

Stool submission by general practitioners in SW England - when, why, and how? a qualitative study
Stool submission by general practitioners in SW England - when, why, and how? a qualitative study
Background: We know little about when and why general practitioners (GPs) submit stool specimens in patients with diarrhoea. The recent UK-wide intestinal infectious disease (IID2) study found ten GP consultations for every case reported to national surveillance. We aimed to explore what factors influence GP’s decisions to send stool specimens for laboratory investigation, and what guidance, if any, informs them.

Methods: We used qualitative methods that enabled us to explore opinions and ask open questions through 20 telephone interviews with GPs with a range of stool submission rates in England, and a discussion group with 24 GPs. Interviews were transcribed and subjected to content analysis.

Results: Interviews: GPs only sent stool specimens to microbiology if diarrhoea persisted for over one week, after recent travel, or the patient was very unwell. Very few had a systematic approach to determine the clinical or public health need for a stool specimen. Only two GPs specifically asked patients about blood in their stool; only half asked about recent antibiotics, or potential food poisoning, and few asked about patients’ occupations. Few GPs gave patients advice on how to collect specimens.

Results from interviews and discussion group in relation to guidance: All reported that the HPA stool guidance and patient collection instructions would be useful in their clinical work, but only one GP (an interviewee) had previously accessed them. The majority of GPs would value links to guidance on electronic requests. Most GPs were surprised that a negative stool report did not exclude all the common causes of IID.

Conclusions: GPs value stool culture and laboratories should continue to provide it. Patient instructions on how to collect stool specimens should be within stool collection kits. Through readily accessible guidance and education, GPs need to be encouraged to develop a more systematic approach to eliciting and recording details in the patient’s history that indicate greater risk of severe infection or public health consequences. Mild or short duration IID (under one week) due to any cause is less likely to be picked up in national surveillance as GPs do not routinely submit specimens in these cases.
1471-2296
77
McNulty, Cliodna A.M.
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Lasseter, Gemma
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Newby, Katie
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Joshi, Puja
8bfdea0e-1524-4818-beba-4c2494d80800
Yoxall, Harry
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Kumaran, Kalyanaraman
de6f872c-7339-4a52-be84-e3bbae707744
O’Brien, Sarah J.
9b077f2f-a571-4299-aade-61cdbb2afb64
Evans, Mark
5937f8f0-b918-44bc-a811-379c60f79145
McNulty, Cliodna A.M.
efcc95ca-272c-4e8f-aa2d-189d59acfc48
Lasseter, Gemma
5d143f95-5052-41f2-b3a2-b0de64ba63e8
Newby, Katie
b2153504-25bf-4083-aec6-4b8d665894d0
Joshi, Puja
8bfdea0e-1524-4818-beba-4c2494d80800
Yoxall, Harry
d1c8ae03-5b51-4576-9b32-b16e252d3e15
Kumaran, Kalyanaraman
de6f872c-7339-4a52-be84-e3bbae707744
O’Brien, Sarah J.
9b077f2f-a571-4299-aade-61cdbb2afb64
Evans, Mark
5937f8f0-b918-44bc-a811-379c60f79145

McNulty, Cliodna A.M., Lasseter, Gemma, Newby, Katie, Joshi, Puja, Yoxall, Harry, Kumaran, Kalyanaraman, O’Brien, Sarah J. and Evans, Mark (2012) Stool submission by general practitioners in SW England - when, why, and how? a qualitative study. BMC Family Practice, 13, 77. (doi:10.1186/1471-2296-13-77). (PMID:22870944)

Record type: Article

Abstract

Background: We know little about when and why general practitioners (GPs) submit stool specimens in patients with diarrhoea. The recent UK-wide intestinal infectious disease (IID2) study found ten GP consultations for every case reported to national surveillance. We aimed to explore what factors influence GP’s decisions to send stool specimens for laboratory investigation, and what guidance, if any, informs them.

Methods: We used qualitative methods that enabled us to explore opinions and ask open questions through 20 telephone interviews with GPs with a range of stool submission rates in England, and a discussion group with 24 GPs. Interviews were transcribed and subjected to content analysis.

Results: Interviews: GPs only sent stool specimens to microbiology if diarrhoea persisted for over one week, after recent travel, or the patient was very unwell. Very few had a systematic approach to determine the clinical or public health need for a stool specimen. Only two GPs specifically asked patients about blood in their stool; only half asked about recent antibiotics, or potential food poisoning, and few asked about patients’ occupations. Few GPs gave patients advice on how to collect specimens.

Results from interviews and discussion group in relation to guidance: All reported that the HPA stool guidance and patient collection instructions would be useful in their clinical work, but only one GP (an interviewee) had previously accessed them. The majority of GPs would value links to guidance on electronic requests. Most GPs were surprised that a negative stool report did not exclude all the common causes of IID.

Conclusions: GPs value stool culture and laboratories should continue to provide it. Patient instructions on how to collect stool specimens should be within stool collection kits. Through readily accessible guidance and education, GPs need to be encouraged to develop a more systematic approach to eliciting and recording details in the patient’s history that indicate greater risk of severe infection or public health consequences. Mild or short duration IID (under one week) due to any cause is less likely to be picked up in national surveillance as GPs do not routinely submit specimens in these cases.

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Published date: 8 July 2012
Organisations: Faculty of Medicine

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Local EPrints ID: 352561
URI: http://eprints.soton.ac.uk/id/eprint/352561
ISSN: 1471-2296
PURE UUID: bfe28f1a-47a8-4054-bbbf-46da1f62cf60

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Date deposited: 16 May 2013 12:04
Last modified: 25 Nov 2019 20:49

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Contributors

Author: Cliodna A.M. McNulty
Author: Gemma Lasseter
Author: Katie Newby
Author: Puja Joshi
Author: Harry Yoxall
Author: Sarah J. O’Brien
Author: Mark Evans

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