Referrals to a tertiary hospital: a window into clinical management issues in functional gastrointestinal disorders

Abstract
Background and Aim
To investigate the quality of and reasons for referrals of patients with likely functional gastrointestinal disorders (FGID) and explore patients’ experience of clinical management.

Methods
A cross sectional, mixed-methods study was undertaken. Referrals (July 2013–2015) to one gastroenterology outpatient department triaged as “likely FGID”, the referred patients and their referring primary healthcare providers were examined.

Results
A total of 69% of patients reported not yet receiving an initial diagnosis, 52% reported persistent/distressing symptoms or reduced quality of life, 24% feared missed or worsening pathology, and 35% were seeking repeat specialist consultation. Most patients were dissatisfied (40%) or only partially satisfied (36%) with current management. Dissatisfaction was significantly related to the lack of provision of a diagnosis and effective treatment options (P < 0.001). Referral quality was poor and with the reason for referral clearly communicated in only 25%. Common referral reasons included repeat presentations (n = 32), diagnostic uncertainty (n = 19), to ensure nothing is missed (n = 19), patient request (n = 17), no response to treatment (n = 16), and to allay patient fears (n = 14). A total of 28/60 primary healthcare providers were confident that their patient had a FGID, yet sought confirmation (n = 16), second opinion (n = 8), or advice (n = 4).

Conclusion
Current management of FGID in usual care is suboptimal, as evidenced by the tertiary referral load, patient dissatisfaction, and the lack of provision of diagnoses and effective treatment options. Some clinicians lack confidence in effectively identifying and managing these conditions. Resources and supports to equip and assist clinicians to identify and manage FGID successfully may enhance patient care.