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.

Charles University 1st Faculty of Medicine Institute of General Practice 7 Albertov Street 128 43 Prague Czech Republic

Jagiellonian University Medical College Department of Family Medicine 4 Bochenska Street 31 061 Krakow Poland

National Center for Quality Assessment in Health Care 60 Kapelanka Street 30 347 Krakow Poland

See more in PubMed

Bolling-Sternevald E, Aro P, Ronkainen J, Storskrubb T, Talley NJ, Junghard O, et al. Do gastrointestinal symptoms fluctuate in the short-term perspective? The Kalixanda study. Dig Dis. 2008;26:256–63. PubMed

Agréus L, Talley NJ, Sheen A, Johansson SE, Jones MP, Svardsudd K. Predictors and non-predictors of symptom relief in dyspepsia consultations in primary care. Dig Dis. 2008;26:248–55. PubMed

Everhart JE, Ruhl CE. Burden of digestive diseases in the United States: part I: overall and upper gastrointestinal diseases. Gastroenterology. 2009;136:376–86. PubMed

Williams JG, Roberts SE, Ali MF, Cheung WY, Cohen DR, Demery G, et al. Gastroenterology services in the UK: the burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence. Gut. 2007;56(Suppl 1):1–113. PubMed PMC

Aro P, Talley NJ, Agréus L, Johansson SE, Bolling-Sternevald E, Storskrubb T, et al. Functional dyspepsia impairs quality of life in the adult population. Aliment Pharmacol Ther. 2011;33:1215–24. PubMed

Halder SL, Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ. Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case-control study. Aliment Pharmacol Ther. 2004;19:233–42. PubMed

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet] Lyon, France: International Agency for Research on Cancer; 2013. Available Feb 27, 2014 from: http://globocan.iarc.fr.

Center MM, Jemal A, Smith RA, Ward E. Worldwide variations in colorectal cancer. CA Cancer J Clin. 2009;59:366–78. PubMed

Seifert B, Svab I, Madis T, Kersnik J, Windak A, Steflova A, et al. Perspectives of family medicine in Central and Eastern Europe. Fam Pract. 2008;25:113–8. PubMed

Rechel B, McKee M. Health reform in Central and Eastern Europe and the former Soviet Union. Lancet. 2009;374:1186–95. PubMed

Albreht T, Klazinga N. Privatisation of health care in Slovenia in the period 1992–2008. Health Policy. 2009;90:262–9. PubMed

Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection -- the Maastricht IV/Florence Consensus Report. Gut. 2012;61:646–64. PubMed

Delaney B, Ford AC, Forman D, Moayyedi P, Qume M. Initial management strategies for dyspepsia. Cochrane Database Syst Rev. 2005:CD001961. PubMed

Butterly LF, Goodrich M, Onega T, Greene MA, Srivastava A, Burt R, et al. Improving the quality of colorectal cancer screening: assessment of familial risk. Dig Dis Sci. 2010;55:754–60. PubMed PMC

Regula J, Kaminski MF. Targeting risk groups for screening. Best Pract Res Clin Gastroenterol. 2010;24:407–16. PubMed

Seifert B, Rubin G, de Wit N, Lionis C, Hall N, Hungin P, et al. The management of common gastrointestinal disorders in general practice: a survey by the European Society for Primary Care Gastroenterology (ESPCG) in six European countries. Dig Liver Dis. 2008;40:659–66. PubMed

Gisbert JP, Cooper A, Karagiannis D, Hatlebakk J, Agréus L, Jablonowski H, et al. Management of gastro-oesophageal reflux disease in primary care: a European observational study. Curr Med Res Opin. 2009;25:2777–84. PubMed

Tosetti C, Bellentani S, Benedetto E, Ubaldi E, Cardin F, Bozzani A, et al. The management of patients with new onset of upper gastro-intestinal symptoms in primary care. Dig Liver Dis. 2010;42:860–4. PubMed

Tomasik T, Windak A, Seifert B, Kersnik J, Palka M, Margas G, et al. The self-perceived role of general practitioners in care of patients with cardiovascular diseases: a survey in Central and Eastern European countries following health care reforms. Int J Cardiol. 2013;164:327–33. PubMed

Tomasik T, Windak A, Jozwiak J, Oleszczyk M, Seifert B, Kersnik J, et al. Treatment of hypertension in Central and Eastern European countries: self-reported practice of primary care physicians. J Hypertens. 2012;30:1671–8. PubMed

Tomasik T, Windak A, Seifert B, Kersnik J, Kijowska V, Dubas K. Lipid--lowering pharmacotherapy in central and eastern European countries in cardiovascular prevention: self-reported prescription patterns of primary care physicians. J Cardiovasc Pharmacol Ther. 2013;18:234–42. PubMed

Spiegel BM, Farid M, van Oijen MG, Laine L, Howden CW, Esrailian E. Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists and primary-care providers. Aliment Pharmacol Ther. 2009;29:871–81. PubMed PMC

Bretagne JF, Honnorat C, Richard-Molard B, Soufflet C, Barthélemy P. Perceptions and practices on the management of gastro-oesophageal reflux disease: results of a national survey comparing primary care physicians and gastroenterologists. Aliment Pharmacol Ther. 2007;25:823–33. PubMed

Halpern R, Kothari S, Fuldeore M, Zarotsky V, Porter V, Dabbous O, et al. GERD-related health care utilization, therapy, and reasons for transfer of GERD patients between primary care providers and gastroenterologists in a US managed care setting. Dig Dis Sci. 2010;55:328–37. PubMed PMC

Boparai V, Rajagopalan J, Triadafilopoulos G. Guide to the use of proton pump inhibitors in adult patients. Drugs. 2008;68:925–47. PubMed

Batuwitage BT, Kingham JG, Morgan NE, Bartlett RL. Inappropriate prescribing of proton pump inhibitors in primary care. Postgrad Med J. 2007;83:66–8. PubMed PMC

Olynyk JK, Aquilia S, Platell CF, Fletcher DR, Henderson S, Dickinson JA. Colorectal cancer screening by general practitioners: comparison with national guidelines. Med J Aust. 1998;168:331–4. PubMed

Sladden MJ, Ward JE. Australian general practitioners’ views and use of colorectal cancer screening tests. Med J Aust. 1999;170:110–3. PubMed

Hanks H, Veitch C, Harris M. Colorectal cancer management – the role of the GP. Aust Fam Physician. 2008;37:259–61. PubMed

Heintze C, Matysiak-Klose D, Kröhn T, Wolf U, Brand A, Meisner C, et al. Diagnostic work-up of rectal bleeding in general practice. Br J Gen Pract. 2005;55:14–9. PubMed PMC

Mauri D, Pentheroudakis G, Milousis A, Xilomenos A, Panagoulopoulou E, Bristianou M, et al. Colorectal cancer screening awareness in European primary care. Cancer Detect Prev. 2006;30:75–82. PubMed

Xilomenos A, Mauri D, Kamposioras K, Gkinosati A, Zacharias G, Sidiropoulou V, et al. Colorectal cancer screening awareness among physicians in Greece. BMC Gastroenterol. 2006;6:18. PubMed PMC

Spiegel BM, Farid M, Esrailian E, Talley J, Chang L. Is irritable bowel syndrome a diagnosis of exclusion?: a survey of primary care providers, gastroenterologists, and IBS experts. Am J Gastroenterol. 2010;105:848–58. PubMed PMC

Gladman LM, Gorard DA. General practitioner and hospital specialist attitudes to functional gastrointestinal disorders. Aliment Pharmacol Ther. 2003;17:651–4. PubMed

Olafsdottir LB, Gudjonsson H, Jonsdottir HH, Jonsson JS, Bjornsson E, Thjodleifsson B. Irritable bowel syndrome: physicians’ awareness and patients’ experience. World J Gastroenterol. 2012;18:3715–20. PubMed PMC

Oleszczyk M, Svab I, Seifert B, Krztoń-Królewiecka A, Windak A. Family medicine in post-communist Europe needs a boost. Exploring the position of family medicine in healthcare systems of Central and Eastern Europe and Russia. BMC Fam Pract. 2012;13:15. PubMed PMC

Klemenc-Ketis Z, Peterlin B. Family physicians’ self-perceived importance of providing genetic test information to patients: a cross-sectional study from Slovenia. Med Sci Monit. 2014;20:434–7. PubMed PMC

Hawley ST, Foxhall L, Vernon SW, Levin B, Young JE. Colorectal cancer screening by primary care physicians in Texas: a rural–urban comparison. J Cancer Educ. 2001;16:199–204. PubMed

VanGeest JB, Johnson TP, Welch VL. Methodologies for improving response rates in surveys of physicians: a systematic review. Eval Health Prof. 2007;30:303–21. PubMed

Spiegel BM, Farid M, Esrailian E, Talley J, Chang L. Is irritable bowel syndrome a diagnosis of exclusion?: a survey of primary care providers, gastroenterologists, and IBS experts. Am J Gastroenterol. 2010;105:848–58. PubMed PMC

Almansa C, Díaz-Rubio M, Rey E. The burden and management of patients with IBS: results from a survey in spanish gastroenterologists. Rev Esp Enferm Dig. 2011;103:570–5. PubMed

Kuiper T, Marsman WA, Jansen JM, van Soest EJ, Haan YC, Bakker GJ, et al. Accuracy for optical diagnosis of small colorectal polyps in nonacademic settings. Clin Gastroenterol Hepatol. 2012;10:1016–20. PubMed

Zavoral M, Suchanek S, Zavada F, Dusek L, Muzik J, Seifert B, et al. Colorectal cancer screening in Europe. World J Gastroenterol. 2009;15:5907–15. PubMed PMC

Berberat PO, de Wit NJ, Bockhorn M, Lundell L, Drenth JP. Training innovations in gastroenterology and educational resources: a new vision of gastrointestinal education across Europe. Eur J Gastroenterol Hepatol. 2010;22:1393–6. PubMed

Federici A, Giorgi Rossi P, Bartolozzi F, Farchi S, Borgia P, Guastcchi G. The role of GPs in increasing compliance to colorectal cancer screening: a randomised controlled trial (Italy) Cancer Causes Control. 2006;17:45–52. PubMed

Hart AR, Barone TL, Gay SP, Inglis A, Griffin L, Tallon CA, et al. The effect on compliance of a health education leaflet in colorectal cancer screening in general practice in central England. J Epidemiol Community Health. 1997;51:187–91. PubMed PMC

Grielen SJ, Boerma WGW, Groenewegen PP. Unity or diversity? Task profiles of general practitioners in central and eastern Europe. Eur J Public Health. 2000;10:249–54.

Hurley RE, Freund DA, Gage BJ. Gatekeeper effects on patterns of physician use. J Fam Pract. 1991;32:167–74. PubMed

Gosden T, Forland F, Kristiansen IS, Sutton M, Leese B, Giuffrida A, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database Syst Rev. 2000;3:CD002215. PubMed PMC

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Group GC. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20. PubMed

Talley NJ, Vakil N Gastroenterology PPCotACo. Guidelines for the management of dyspepsia. Am J Gastroenterol. 2005;100:2324–37. PubMed

Loyd RA, McClellan DA. Update on the evaluation and management of functional dyspepsia. Am Fam Physician. 2011;83:547–52. PubMed

Malfertheiner P, Megraud F, O’Morain CA, Bazzoli F, El-Omar E, Graham D, et al. Management of Helicobacter pylori infection -- the Maastricht IV/Florence Consensus Report. Gut. 2012;61:646–64. PubMed