Sladden M J, Thomson A N
Division of Community and Rural Health, University of Tasmania.
Aust Fam Physician. 1998 Jan-Feb;27(1-2):78-82.
To determine how general practitioners (GPs) in northern Tasmania manage rectal bleeding in terms of examination, referral, and patient investigation and estimate the value of early diagnosis of colorectal cancer (CRC).
Self reported postal questionnaire survey sent to 100 randomly selected GPs in northern Tasmania.
Sixty-eight per cent of GPs responded. The clinical action proposed by GPs varied considerably according to patient age and type of rectal bleeding. The proportion of GPs who would refer a patient to a specialist varied from 15 to 100% depending on the specific scenario. Responses were not consistent with the available consensus guidelines and evidence. Most GPs believed that early diagnosis of CRC through screening and the early detection of rectal bleeding improved outcomes. However, fewer than half the respondents believed that there were clear guidelines about the management of a patient with rectal bleeding, emphasising the need for evidence-based guidelines which are effectively disseminated and clinically evaluated. Rural GPs indicated that distance from specialist investigation and referral centres would influence patient management.
There is a wide variation in the way GPs manage rectal bleeding and inconsistent knowledge about the existence of guidelines for managing rectal bleeding. Evidence-based education about the management of this common clinical problem, which is effectively disseminated and clinically evaluated, would seem appropriate.
确定塔斯马尼亚岛北部的全科医生（GPs）在直肠出血的检查、转诊及患者调查方面是如何进行处理的，并评估早期诊断结直肠癌（CRC）的价值。
向塔斯马尼亚岛北部随机选取的100名全科医生发送自填式邮政问卷调查。
68%的全科医生做出了回应。全科医生建议的临床行动根据患者年龄和直肠出血类型有很大差异。根据具体情况，将患者转诊给专科医生的全科医生比例从15%到100%不等。其回答与现有的共识指南和证据不一致。大多数全科医生认为，通过筛查早期诊断结直肠癌以及早期发现直肠出血可改善治疗结果。然而，不到一半的受访者认为有关于直肠出血患者管理的明确指南，这强调了需要有循证指南，并进行有效传播和临床评估。乡村全科医生表示，与专科检查和转诊中心的距离会影响患者管理。
全科医生处理直肠出血的方式差异很大，且对直肠出血管理指南的存在情况了解不一致。对这一常见临床问题的管理进行有效传播和临床评估的循证教育似乎是合适的。
