Published online Nov 14, 2017. doi: 10.3748/wjg.v23.i42.7635
Peer-review started: August 4, 2017
First decision: August 30, 2017
Revised: September 13, 2017
Accepted: October 18, 2017
Article in press: October 19, 2017
Published online: November 14, 2017
Irritable bowel syndrome (IBS) is a chronic recurrent functional bowel disorder which impairs patients’ quality of life. Patients with IBS report poor treatment response and satisfaction rates for traditional treatments and undergo frequent consultations and referrals. In China, data for predictors of healthcare-seeking behavior and satisfaction with medical care are lacking. Studies regarding predictors for healthcare-seeking behavior among patients with IBS may provide evidence for IBS management strategies in this region.
The present study comprehensively summarized the characteristics of healthcare-seeking behavior, medical costs, and satisfaction with care among Chinese patients with IBS. The authors also investigated predictors for frequent consultations, frequent colonoscopies, dissatisfaction with medical care, and long-term and multiple medications among Chinese patients with IBS. The authors’ study provides a basis for future studies on healthcare-seeking behavior among patients with IBS, and may provide management guidance for clinicians.
The main objectives of this study were to investigate the characteristics of healthcare-seeking behavior, medical costs, and satisfaction with care among Chinese patients with IBS, and determine predictors for frequent consultations, frequent colonoscopies, dissatisfaction with medical care, and long-term and multiple medications in this population.
The authors enrolled patients with IBS who met Rome III diagnostic criteria and excluded organic diseases in a tertiary gastroenterology clinic from 2009 to 2016. Patients were administered IBS questionnaires in face-to-face interviews, which included intestinal and extra-intestinal symptoms, medical consultations and management. Data were collected and analyzed with SPSS version 19.0 software. Patients were divided into frequent consulters and infrequent consulters; frequent colonoscopies and infrequent colonoscopies; long-term medications and intermittent medications; medications ≥ 3 kinds and medications < 3 kinds; satisfaction with medical care and dissatisfaction with medical care. Univariate analysis was conducted with χ2 test to detect factors with significant differences between groups and the significant different factors above were entered into a multivariate logistic regression model to determine independent predictors for their healthcare-seeking behavior.
The authors found Chinese IBS patient present high rates of frequent healthcare- seeking behavior, colonoscopies, medications and low satisfaction with medical care. Abdominal pain/discomfort during non-defecation period (ordinary abdominal pain/discomfort) instead of pre-defecation abdominal pain/discomfort was the independent predictor for their healthcare-seeking behavior. Sensation of incomplete evacuation was the independent predictor for frequent colonoscopies. Patients with anxiety were more likely to report “dissatisfaction to medical care”. In the past year, patients with severe and persistent IBS symptoms sought medical care frequently. How to educate patients and obtain reasonable utilization of medical resources need to be solved.
The results demonstrated that most patients with IBS were partially responsive to traditional treatment. Intestinal symptoms were major predictors for healthcare-seeking behavior, and patients with anxiety were more likely to be dissatisfied with medical care. The authors’ results provided guidance for Chinese IBS management. Doctors should pay attention to patients with specific symptoms such as ordinary abdominal pain/discomfort and anxiety.
From the study, The authors learned that patients with IBS tended to undergo frequent consultations and investigations. Physicians should give patients sufficient explanations and pay attention to their psychological status. Future researches might emphasize the reasons of low effective rate of routine treatments and investigate the efficacy of psychological treatment through prospective studies.