Health Protection Agency, Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK.
BMC Fam Pract. 2012 Aug 8;13:77. doi: 10.1186/1471-2296-13-77.
We know little about when and why general practitioners (GPs) submit stool specimens in patients with diarrhoea. The recent UK-wide intestinal infectious disease (IID2) study found ten GP consultations for every case reported to national surveillance. We aimed to explore what factors influence GP's decisions to send stool specimens for laboratory investigation, and what guidance, if any, informs them.
We used qualitative methods that enabled us to explore opinions and ask open questions through 20 telephone interviews with GPs with a range of stool submission rates in England, and a discussion group with 24 GPs. Interviews were transcribed and subjected to content analysis.
Interviews: GPs only sent stool specimens to microbiology if diarrhoea persisted for over one week, after recent travel, or the patient was very unwell. Very few had a systematic approach to determine the clinical or public health need for a stool specimen. Only two GPs specifically asked patients about blood in their stool; only half asked about recent antibiotics, or potential food poisoning, and few asked about patients' occupations. Few GPs gave patients advice on how to collect specimens.Results from interviews and discussion group in relation to guidance: All reported that the HPA stool guidance and patient collection instructions would be useful in their clinical work, but only one GP (an interviewee) had previously accessed them. The majority of GPs would value links to guidance on electronic requests. Most GPs were surprised that a negative stool report did not exclude all the common causes of IID.
GPs value stool culture and laboratories should continue to provide it. Patient instructions on how to collect stool specimens should be within stool collection kits. Through readily accessible guidance and education, GPs need to be encouraged to develop a more systematic approach to eliciting and recording details in the patient's history that indicate greater risk of severe infection or public health consequences. Mild or short duration IID (under one week) due to any cause is less likely to be picked up in national surveillance as GPs do not routinely submit specimens in these cases.
我们对全科医生（GP）何时为何会在腹泻患者中送检粪便样本知之甚少。最近在英国进行的一项全国家庭传染性疾病（IID2）研究发现，每报告一例此类疾病，就有 10 例 GP 就诊。我们旨在探讨哪些因素影响 GP 决定送检粪便样本进行实验室检查，以及他们是否有任何指导。
我们采用了定性方法，通过对英格兰粪便送检率不同的 20 名 GP 进行电话访谈，并与 24 名 GP 进行小组讨论，探讨了他们的意见并提出了开放性问题。访谈内容被转录，并进行了内容分析。
访谈：如果腹泻持续超过一周、最近有旅行史或患者病情非常严重，GP 才会将粪便样本送去微生物学检查。很少有 GP 采用系统的方法来确定临床或公共卫生是否需要进行粪便样本检查。只有两名 GP 专门询问了患者粪便中是否有血；只有一半 GP 询问了最近是否使用过抗生素、是否有食物中毒的可能，很少有 GP 询问患者的职业。很少有 GP 会向患者提供收集样本的建议。访谈和小组讨论中与指导相关的结果：所有 GP 均表示 HPA 粪便指南和患者收集说明在他们的临床工作中会很有用，但只有一名 GP（访谈对象）之前曾使用过。大多数 GP 会重视与电子请求相关的指导链接。大多数 GP 感到惊讶的是，粪便报告阴性并不能排除所有常见的 IID 病因。
GP 重视粪便培养，实验室应继续提供。应在粪便收集套件中提供患者收集粪便样本的说明。通过易于获取的指导和教育，应鼓励 GP 发展更系统的方法，以引出并记录患者病史中的详细信息，这些信息表明存在更严重感染或公共卫生后果的更高风险。由于任何原因导致的轻度或持续时间较短（一周内）的 IID 不太可能在国家监测中被发现，因为 GP 通常不会在这些情况下送检样本。
