Abstract
The criteria used when GPs submit stool specimens for microbiological investigation are unknown. To determine what criteria GPs use to send stool specimens, and if they are consistent with national guidance, and whether GPs would prescribe an antibiotic before they receive a result. Questionnaire survey of 974 GPs in 172 surgeries in England. GPs were sent a questionnaire (23 questions) based on national guidance. Questionnaires were returned by 90% (154/172) of surgeries and 49% (477/968) of GPs. GPs reported sending stool specimens in about 50% of cases of suspected infectious diarrhoea, most commonly because of individual symptoms, rather than public health implications. Fewer considered sampling with antibiotic-associated diarrhoea post hospitalisation, or children with acute, painful, bloody diarrhoea; only 14% mentioned outbreaks as a reason. Nearly one-half of GPs reported they would consider antibiotics in suspected cases of Escherichia coli O157, which is contraindicated. Only 23% of GPs would send the recommended three specimens for ova, cysts, and parasites (OCP) examination. Although 89% of GPs gave some verbal advice on how to collect stool specimens, only 2% of GPs gave patients any written instructions. GPs need more education to address gaps in knowledge about the risks and diagnosis of different infections in suspected infectious diarrhoea, especially Clostridium difficile post-antibiotics, E. coli O157, and requesting OCPs. Advice on reports, tick boxes, or links to guidance on electronic request forms may facilitate this.
Highlights
Since the Health Protection Regulations were updated in 2010, medical practitioners are obliged to report cases of infectious bloody diarrhoea, food poisoning, and haemolytic uraemic syndrome (HUS).[1]
Tick boxes, or links to guidance on electronic request forms may facilitate this
In a recent qualitative interview study of 20 English GPs, the majority of participants reported that stool specimen microbiology was useful but should not be routine, as most cases of suspected infectious diarrhoea were self-limiting and most patients did not usually require specific antibiotic treatment.[2]
Summary
Since the Health Protection Regulations were updated in 2010, medical practitioners are obliged to report cases of infectious bloody diarrhoea, food poisoning, and haemolytic uraemic syndrome (HUS).[1] National guidance was issued to GPs and other medical practitioners that explained the obligations under the new legislation.[1] In a recent qualitative interview study of 20 English GPs, the majority of participants reported that stool specimen microbiology was useful but should not be routine, as most cases of suspected infectious diarrhoea were self-limiting and most patients did not usually require specific antibiotic treatment.[2] This reported behaviour has been backed up by data from a longitudinal study of infectious intestinal disease (IID) in the UK, which showed that there were 147 community cases of IID and 10 GP consultations for every case reported to national surveillance.[3] In the current study, limited but rich qualitative data were used from the previous study,[2] to develop a questionnaire to collect data from a much larger sample of GPs. The aim was to determine what clinical and public health criteria GPs use to decide when to send stool specimens, what (including national guidance) informs these management decisions, whether GPs would prescribe.
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