P269. A qualitative exploration of inflammatory bowel disease patient perceptions of primary care in the UK
K. Kemp1, J. Griffiths2, S. Campbell3, K. Lovell2
1University of Manchester/Manchester Royal Infirmary, School of Nursing/Gastroenterology, Manchester, United Kingdom; 2University of Manchester, School of Nursing, Manchester, United Kingdom; 3Manchester Royal Infirmary, Gastroenterology, Manchester, United Kingdom
Background: Many patients with IBD in the UK are managed primarily in secondary care with minimal General Practitioner (GP) involvement or within a restricted shared care protocol. As UK NHS hospitals face mounting financial and workforce pressures, reconfiguration of hospital services can provide a powerful means of improving the quality of patient care. The issue as to whether GPs should be more involved with IBD care must be addressed and the patient's attitudes and perceptions ofthe GP and potential role, should be a focus when restructuring healthcare services.
Methods: 24 in depth qualitative interviews with 24 IBD patients were conducted as part of a larger study to develop a model of follow up care for patients with IBD. 18 patients had Crohns Disease, 6 ulcerative colitis, age range 2772 years, disease duration range was 240yrs. Interviews were 40 to 60 minutes duration. Patients were asked directly about the role of their GP in their diagnosis and ongoing care of their IBD. Thematic analysis of interviews was undertaken using NVivo 9.0.
Results: Many patients experienced years of symptoms prior to diagnosis, in one case diagnosis took 10 years. This misdiagnosis/mistreatment led to a loss of confidence in the GP for future care. This impacted upon the question if they seek help from their GP at times of flares or IBD related problems. All patients reported no they do not seek help from their GP. This loss of confidence at diagnosis promoted views that their GP did not have the level of knowledge nor expertise to manage ongoing care. This was the same for patients with complex and quiescent disease. Patients would be happy to increase the level of input from their GP but this must be under the direction of the IBD team. Patients do not wish to be discharged completely from the IBD team and would accept reduced intervention and face to face contact with their IBD team, such as telephone and virtual clinics, in order to remain under the care of the IBD team.
Conclusions: GPs are the sole carers for a minority of IBD patients. While patients are willing to accept greater involvement from their GP there is general lack of confidence in their expertise to do this effectively. This is reflected by pts expressing a wish to remain under the direct care of the IBD team within secondary care. It is clear from the data that there may be an educational developmental need for the GPs regarding IBD but there is potential for reconfiguration of IBD services in which the GP plays a greater role.