Background: Gastrointestinal disorders account for 7-10% of all consultations in primary care. General practitioners' management of digestive disorders in Central and Eastern European countries is largely unknown.
Aims: To identify and compare variations in the self-perceived responsibilities of general practitioners in the management of digestive disorders in Central and Eastern Europe.
Methods: A cross-sectional survey of a randomized sample of primary care physicians from 9 countries was conducted. An anonymous questionnaire was sent via post to primary care doctors.
Results: We received 867 responses; the response rate was 28.9%. Over 70% of respondents reported familiarity with available guidelines for gastrointestinal diseases. For uninvestigated dyspepsia in patients under 45 years, the "test and treat" strategy was twice as popular as "test and scope". The majority (59.8%) of family physicians would refer patients with rectal bleeding without alarm symptoms to a specialist (from 7.6% of doctors in Slovenia to 85.1% of doctors in Bulgaria; p<0.001). 93.4% of respondents declared their involvement in colorectal cancer screening. In the majority of countries, responding doctors most often reported that they order fecal occult blood tests. The exceptions were Estonia and Hungary, where the majority of family physicians referred patients to a specialist (p<0.001).
Conclusions: Physicians from Central and Eastern European countries understood the need for the use of guidelines for the care of patients with gastrointestinal problems, but there is broad variation between countries in their management. Numerous efforts should be undertaken to establish and implement international standards for digestive disorders' management in general practice.
Uvod: 7–10 % vseh posvetov v primarni zdravstveni oskrbi se nanaša na bolezni prebavil. O zdravljenju bolezni prebavil s strani splošnih zdravnikov v Srednji in Vzhodni Evropi ni na razpolago veliko podatkov.
Cilji: Ugotoviti in primerjati razlike v samozaznani odgovornosti splošnih zdravnikov pri zdravljenju bolezni prebavil v Srednji in Vzhodni Evropi.
Metode: Naredili smo presečne ankete na randomiziranem vzorcu splošnih zdravnikov v primarni zdravstveni oskrbi iz devetih držav. Po pošti smo zdravnikom v primarni zdravstveni oskrbi poslali anonimni vprašalnik.
Rezultati: Prejeli smo 867 odgovorov, stopnja odzivnosti je bila 28,9 %. Več kot 70 % anketirancev je v odgovorih navedlo, da so seznanjeni z razpoložljivimi smernicami za bolezni prebavil. Za neraziskano dispepsijo pri bolnikih, mlajših od 45 let, je bila dvakrat bolj priljubljena strategija »testiranja in zdravljenja« kot pa strategija »testiranja in gastroskopije«. Večina (59,8 %) zdravnikov v primarni zdravstveni oskrbi bi bolnike z rektalnimi krvavitvami brez znakov alarma napotila k specialistu (od 7,6 % zdravnikov v Sloveniji do 85,1 % zdravnikov v Bolgariji; p<0.001). 93,4 % anketirancev je potrdilo svojo udeležbo pri presejalnih pregledih za odkrivanje raka debelega črevesa in danke. V večini držav so zdravniki najpogosteje poročali, da naročajo testiranje za odkrivanje prikritih krvavitev v blatu. Izjema pri tem sta bili Estonija in Madžarska, kjer večina zdravnikov v primarni zdravstveni oskrbi napoti paciente k specialistu (p<0.001).
Zaključki: Zdravniki iz Srednje in Zahodne Evrope razumejo potrebo po uporabi smernic za nego bolnikov z boleznimi prebavil, vendar pa je pri obravnavi veliko razlik med posameznimi državami. Treba si je prizadevati in sprejeti ukrepe za vzpostavitev in izvajanje mednarodnih standardov za obravnavo bolezni prebavil v splošni praksi.
Keywords: General practice; colorectal neoplasms; gastroesophageal reflux; gastrointestinal diseases; irritable bowel syndrome.