Intern Med J. 2024 Dec 2. doi: 10.1111/imj.16591. Online ahead of print.

Ryan M Mathias ^1 2 3, Samantha L Plush ^1 2 3 4, Elka J S Fairhead ⁴, Benjamin Ngoi ⁵, Louisa Edwards ⁵, Alice S Day ^1 2 3 4, Robert V Bryant ^1 2 3

Author information

¹Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.

²Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia.

³School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.

⁴Department of Nutrition & Dietetics, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.

⁵Central Adelaide Local Health Network, Adelaide, South Australia, Australia.

Abstract

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.