Ng Kheng-Seong, Soares Deanne S, Koneru Sireesha, Manocha Ramesh, Gladman Marc Antony
The Bowel Clinic, Adelaide, Australia.
Sydney Medical School, University of Sydney, Sydney, Australia.
BJGP Open. 2021 Jun 30;5(3). doi: 10.3399/BJGPO.2020.0182. Print 2021 Jun.
GPs play an important role in the diagnosis and management of patients with faecal incontinence (FI). However, their confidence and ability in this role are unknown.
This study aimed to investigate the knowledge, skills, and confidence of GPs to manage FI in primary care, and identify barriers to optimal management.
DESIGN & SETTING: A cross-sectional study using self-administered questionnaires of GPs attending health education seminars, which took place across Australian capital cities.
Main outcome measures included: (i) clinical exposure to and previous training in FI; (ii) knowledge and skills in screening, diagnosing, and managing FI; and (iii) barriers and facilitators to optimising care. Associations between demographics, training and knowledge and skills were assessed.
Some 1285 of 1469 GPs (87.5%) participated (mean 47.7 years [standard deviation {SD} 11.3]). The vast majority reported poor clinical exposure to (88.5%) and training in FI management (91.3%). Subjectively, 69.7% rated their knowledge and skills in screening, assessing, and treating FI as suboptimal. The most commonly reported barrier to FI care was 'insufficient skills' (56.1%); facilitators were improved referral pathways (84.6%) and increased training (67.9%). GPs with more training had better knowledge (odds ratio [OR] = 24.62, 95% confidence interval [CI] = 13.32 to 45.51) and skills (OR = 13.87, 95% CI = 7.94 to 24.24) in managing FI.
Clinical exposure to and training in FI among GPs was poor. Accordingly, knowledge, skills, and confidence to manage FI was suboptimal. GPs recognise the importance of FI and that increased training and/or education and formalisation of referral pathways may improve the care of patients with FI in primary care.
全科医生在大便失禁（FI）患者的诊断和管理中发挥着重要作用。然而，他们在这一角色中的信心和能力尚不清楚。
本研究旨在调查全科医生在初级保健中管理FI的知识、技能和信心，并确定优化管理的障碍。
一项横断面研究，采用自我管理问卷对参加澳大利亚各首府城市健康教育研讨会的全科医生进行调查。
主要结局指标包括：（i）FI的临床接触情况和既往培训情况；（ii）FI筛查、诊断和管理的知识和技能；（iii）优化护理的障碍和促进因素。评估人口统计学、培训与知识和技能之间的关联。
1469名全科医生中有1285名（87.5%）参与（平均年龄47.7岁[标准差{SD}11.3]）。绝大多数人报告称，他们对FI的临床接触情况不佳（88.5%），且FI管理培训不足（91.3%）。主观上，69.7%的人认为他们在FI筛查、评估和治疗方面的知识和技能欠佳。FI护理最常报告的障碍是“技能不足”（56.1%）；促进因素是转诊途径改善（84.6%）和培训增加（67.9%）。接受更多培训的全科医生在管理FI方面具有更好的知识（优势比[OR]=24.62，95%置信区间[CI]=13.32至45.51）和技能（OR=13.87，95%CI=7.94至24.24）。
全科医生对FI的临床接触和培训情况不佳。因此，管理FI的知识、技能和信心欠佳。全科医生认识到FI的重要性，增加培训和/或教育以及转诊途径的规范化可能会改善初级保健中FI患者的护理。
