Acute Gastroenteritis in Ireland, North and South - A Study of General Practitioners

• Project start date: 21 February 2000
• Project status: Completed
• Project type: Food safety
• Discipline: Microbiology and food hygiene

Research objective

The primary aim of this study was to investigate the management of acute infectious gastroenteritis by general practitioners (GPs) in Ireland. Given that GPs are the main healthcare providers and the first point of contact for patients, the study sought to examine the burden of disease presented to GPs and their responses to the problem. Objectives included understanding the incidence and management of gastroenteritis cases in general practice, assessing GPs' attitudes and practices related to the clinical management and surveillance of gastroenteritis, and identifying factors influencing GPs' decisions to request stool samples and notify public health authorities. The study aimed to provide insights into GPs' roles in advising high-risk patients and enhancing communication between GPs and public health authorities.

Outputs

Research report

• Title: Acute Gastroenteritis in Ireland, North and South - A Study of General Practitioners
• Publication date: 6 February 2003
• Summary: The research aimed to investigate how general practitioners (GPs) manage acute infectious gastroenteritis in Ireland. Using both quantitative and qualitative methods, the study involved focus groups, semi-structured interviews, and a postal survey of GPs across Ireland. The survey, conducted in autumn 2002, gathered data on GP consultations, stool sample requests, treatment practices, and notification to public health authorities. The study duration was 18 months, with a 57% response rate from 1,204 surveyed GPs.
• Findings:

  Infectious gastroenteritis causes substantial morbidity and economic loss on the island of Ireland. A population study published in 2003 showed there were 3.2 million episodes of acute gastroenteritis (GE), or 8,080 new cases per day. With an average duration of illness of four days, this means that 35,000 people are ill each day, mostly children and younger adults. Twenty-nine percent of ill people sought medical care, corresponding to a total of 3,100 General Practitioner consultations per day in Ireland. However, these are rarely translated into routine statistics, as in 2002 there were just fewer than 6,000 clinical notifications of infectious gastroenteritis or foodborne diseases.

  The principal aim was to describe general practitioners’ management of patients with acute infectious gastroenteritis. As the GP is the main health provider and first point of contact for patients, we decided to examine in more detail the burden of disease presenting to GPs and the responses of GPs to the problem. As in other countries, information in Ierland regarding GP management of this essentially self-limiting illnes has been limited. From the population study we know that only a fraction of those with acute GE are reported through the statutory notification system or through laboratory-based surveillance systems. We also wished to ascertain the outcome of patients who visit their doctor with acute gastroenteritis and their subsequent management. In particular, we wanted to understand what prompts general practitioners to request stool samples and to notify public health.

  • GPs in the North had more group practices and computerisation than those in the South.
  • There was an average of seven gastroenteritis consultations per week per GP.
  • Telephone consultations were more common in the North.
  • Children and younger adults were the most affected, with toddlers consulting more frequently.
  • 93% of GPs advised extra fluids and continued feeding.
  • No consensus on the use of anti-diarrhoeal agents.
  • Antibiotics prescribed for about 10% of cases, usually after consulting with a microbiologist.
  • Stool sample requests were based on illness duration, severity, suspicion of food poisoning, and recent travel.
  • Patient information on providing stool samples was often inadequate.
  • Notification of foodborne infections to public health was low, especially in the South.
  • Difficulty in transporting stool samples to laboratories was significant in the South.
• Recommendations:
  1. Establish clear guidelines for the use of anti-diarrhoeal agents and antibiotics.
  2. Develop collection services for stool samples in the South.
  3. Laboratories should improve communication with GPs about diagnostic services.
  4. Create patient information leaflets on providing stool specimens.
  5. Enhance two-way communication between public health authorities and GPs.
  6. Provide feedback to GPs on notifications and laboratory reports.
  7. Address GP concerns about patient confidentiality and notification processes.
  8. Develop a postgraduate GP training module on managing acute gastroenteritis.
  9. Coordinate undergraduate and postgraduate training on infectious diseases, focusing on primary care, laboratory sciences, and public health.
  10. Designate a resource person to develop and implement the training curriculum.
  11. Develop appropriate training materials, potentially using CDC resources as a model.