Ansems Sophie M, Berger Marjolein Y, van Tol Donald G, Olthof Marijke, Holtman Gea A
Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Sociology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands.
Eur J Gen Pract. 2024 Dec;30(1):2432417. doi: 10.1080/13814788.2024.2432417. Epub 2024 Dec 2.
General practitioners (GPs) often struggle to distinguish functional gastrointestinal disorders (FGID) from organic disorders in children with chronic abdominal symptoms. A referral strategy guided by faecal calprotectin (FCal) testing may help.
This study explores GPs' experiences with these children and the strategy.
GPs were sampled purposively to data saturation. Ultimately, we conducted one focus group session and 13 semi-structured interviews with 17 Dutch GPs who had been involved in a randomised controlled trial evaluating an FCal-testing strategy. The online focus group and interviews were recorded, transcribed verbatim, and subject to thematic content analysis.
Four themes arose: diagnostic confidence, fear of missing something severe, reassurance and managing FGID in primary care. Although GPs typically felt confident during the diagnostic process, they did fear missing somatic or psychosocial conditions. They felt more diagnostically confident due to FCals clear indications, high diagnostic accuracy, and non-invasiveness. Reassurance was considered crucial in children with FGID, either by labelling symptoms, providing explanatory models, or offering medical interventions (e.g. FCal testing). When helping children with FGID proved too difficult, GPs referred to specialist care. Besides the integration of FCal during reassurance, the testing strategy did not help GPs manage children with FGID.
While the FCal-strategy improved diagnosis according to GPs, they found the primary challenge to be managing children with FGID. Nevertheless, they found the FCal-strategy beneficial, likely due to its integration into reassurance strategies. Further research focusing on enhancing communication and interventions for paediatric FGID in primary care is warranted.
全科医生（GPs）常常难以区分患有慢性腹部症状儿童的功能性胃肠疾病（FGID）与器质性疾病。以粪便钙卫蛋白（FCal）检测为指导的转诊策略可能会有所帮助。
本研究探讨全科医生对这些儿童及该策略的经验。
有目的地抽取全科医生进行数据饱和抽样。最终，我们对17名参与评估FCal检测策略的随机对照试验的荷兰全科医生进行了一次焦点小组讨论和13次半结构化访谈。在线焦点小组讨论和访谈进行了录音、逐字转录，并进行了主题内容分析。
出现了四个主题：诊断信心、担心漏诊严重疾病、安抚以及在初级保健中管理FGID。尽管全科医生在诊断过程中通常感到有信心，但他们确实担心漏诊躯体或心理社会疾病。由于FCal具有明确的指示、较高的诊断准确性和非侵入性，他们在诊断上感觉更有信心。对于患有FGID的儿童，通过对症状进行标记、提供解释模型或提供医疗干预措施（如FCal检测），安抚被认为至关重要。当帮助患有FGID的儿童被证明过于困难时，全科医生会转诊至专科护理。除了在安抚过程中整合FCal外，检测策略并未帮助全科医生管理患有FGID的儿童。
虽然根据全科医生的说法，FCal策略改善了诊断，但他们发现主要挑战在于管理患有FGID的儿童。然而，他们发现FCal策略是有益的，可能是因为它被整合到了安抚策略中。有必要开展进一步研究，重点关注加强初级保健中儿科FGID的沟通和干预措施。
