Gikas Aristofanis, Triantafillidis John K
Health Center of Kalivia, Kalivia, Attiki, Greece.
Inflammatory Bowel Disease Unit, IASO General Hospital, Athens, Greece.
Int J Gen Med. 2014 Mar 13;7:159-73. doi: 10.2147/IJGM.S58888. eCollection 2014.
Chronic gastrointestinal disorders are a source of substantial morbidity, mortality, and cost. They are common in general practice, and the primary care physician (PCP) has a central role in the early detection and management of these problems. The need to make cost-effective diagnostic and treatment decisions, avoid unnecessary investigation and referral, provide long-term effective control of symptoms, and minimize the risk of complications constitute the main challenges that PCPs face. The literature review shows that, although best practice standards are available, a considerable number of PCPs do not routinely follow them. Low rates of colorectal cancer screening, suboptimal testing and treatment of Helicobacter pylori infection, inappropriate use of proton pump inhibitors, and the fact that most PCPs are still approaching the irritable bowel disease as a diagnosis of exclusion represent the main gaps between evidence-based guidelines and clinical practice. This manuscript points out that updating of knowledge and skills of PCPs via continuing medical education is the only way for better adherence with standards and improving quality of care for patients with gastrointestinal diseases.
慢性胃肠疾病是高发病率、高死亡率和高成本的一个根源。它们在普通医疗中很常见，初级保健医生（PCP）在这些问题的早期检测和管理中起着核心作用。做出具有成本效益的诊断和治疗决策、避免不必要的检查和转诊、提供症状的长期有效控制以及将并发症风险降至最低，这些需求构成了初级保健医生面临的主要挑战。文献综述表明，尽管有最佳实践标准，但相当数量的初级保健医生并没有常规遵循这些标准。结直肠癌筛查率低、幽门螺杆菌感染的检测和治疗不理想、质子泵抑制剂的不当使用，以及大多数初级保健医生仍将肠易激综合征作为排除性诊断，这些都是循证指南与临床实践之间的主要差距。本手稿指出，通过继续医学教育更新初级保健医生的知识和技能，是更好地遵循标准并提高胃肠疾病患者护理质量的唯一途径。
