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Physician Diagnostic and Reporting Practices for Gastrointestinal Illnesses in Three Health Regions of British Columbia

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Abstract

Objectives

To estimate seasonal proportions of patient visits due to acute gastrointestinal illness (GI), assess factors influencing physicians’ stool sample requests, their understanding of laboratory testing protocols and adherence to provincial stool request guidelines in three British Columbia (BC) health regions.

Methods

During a one-year period, eligible physicians were mailed four self-administered questionnaires used to estimate proportions of patients diagnosed with GI, related stool sample requests in the preceding month, and to assess factors prompting stool sample requests.

Results

The response rate overall for the initial comprehensive questionnaire was 18.6%; 7.4% responded to all four questionnaires. An estimated 2.5% of patient visits had a GI diagnosis; of these, 24.8% were asked to submit stool samples. Significant (p<0.05) regional and seasonal variations were found in rates of GI and stool sample requests. Top-ranked factors prompting stool sample requests were: bloody diarrhoea, recent overseas travel, immunocompromised status, and duration of illness >7 days; “non-patient” factors included: laboratory availability, time to receive laboratory results, and cost. Physicians’ perceptions of which organisms were tested for in a ‘routine’ stool culture varied.

Interpretation

BC physicians appear to adhere to existing standardized guidelines for sample requests. This may result in systematic under-representation of certain diseases in reportable communicable disease statistics.

Résumé

Objectifs

Estimer, dans trois régions sanitaires de la Colombie-Britannique (C.-B.), les pourcentages saisonniers de visites médicales en raison de maladies gastrointestinales (MGI) aiguës, et déterminer les facteurs incitant les médecins à demander des échantillons de selles, leurs connaissances des protocoles d’essai des laboratoires et leur respect des lignes directrices relatives aux demandes d’échantillons de selles.

Méthode

Sur une période d’un an, les médecins admissibles ont reçu par la poste quatre questionnaires à remplir soi-même, qui ont servi à estimer le pourcentage de patients chez qui une MGI avait été diagnostiquée et le nombre connexe d’échantillons de selles demandés le mois précédent, et à évaluer les facteurs incitant les médecins à demander un échantillon de selles.

Résultats

Le taux global de réponse au premier questionnaire général s’est élevé à 18,6 %, et 7,4 % des médecins ont répondu aux quatre questionnaires. Un taux estimatif de 2,5 % des patients avaient reçu un diagnostic de MGI, et les médecins avaient demandé à 24,8 % d’entre eux de fournir des échantillons de selles. Des variations régionales et saisonnières importantes (p<0,05) ont été observées dans les taux de MGI et de demandes d’échantillons de selles. Les principaux facteurs incitant les médecins à demander un échantillon de selles étaient: la présence de sang dans les selles, un voyage récent à l’étranger, un déficit immunitaire et une maladie qui dure plus de sept jours; les facteurs « extérieurs aux patients » étaient, entre autres, la disponibilité du laboratoire, le temps nécessaire pour recevoir les résultats et les coûts. Les perceptions des médecins au sujet des organismes visés par une culture de selles « de routine » étaient variables.

Interprétation

Les médecins de la C.-B. semblent s’en tenir aux lignes directrices normalisées en vigueur relativement aux demandes d’échantillons de selles, ce qui peut se solder par une sous-représentation systématique de certaines maladies dans les statistiques sur les maladies transmissibles à déclaration obligatoire.

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Author information

Authors and Affiliations

  1. Foodborne, Waterborne and Zoonotic Infections Division, Public Health Agency of Canada, 255 Woodlawn Rd W, Unit 120, Guelph, ON, N1H 8J1, Canada

    Victoria L. Edge MSc, PhD, Shannon E. Majowicz PhD, Kathryn Doré MSc, James A. Flint MPH, Nicole Boom MSc, Pia K. Muchaal MSc & Paul N. Sockett PhD

  2. Department of Population Medicine, University of Guelph, Canada

    Victoria L. Edge MSc, PhD, Shannon E. Majowicz PhD & Kathryn Doré MSc

  3. University of Tennessee, Knoxville, Tennessee, Canada

    Agricola Odoi PhD

  4. British Columbia Centre for Disease Control and Prevention, Vancouver, BC, Canada

    Murray Fyfe MD & Laura MacDougall MSc

  5. Vancouver Island Health Authority, Victoria, BC, Canada

    Murray Fyfe MD

  6. Foodborne, Waterborne and Zoonotic Infections Division, Public Health Agency of Canada, Ottawa, ON, Canada

    Paul N. Sockett PhD

Authors
  1. Victoria L. Edge MSc, PhD
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  2. Agricola Odoi PhD
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  3. Murray Fyfe MD
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  4. Laura MacDougall MSc
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  5. Shannon E. Majowicz PhD
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  6. Kathryn Doré MSc
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  7. James A. Flint MPH
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  8. Nicole Boom MSc
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  9. Pia K. Muchaal MSc
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  10. Paul N. Sockett PhD
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Corresponding author

Correspondence to Victoria L. Edge MSc, PhD.

Additional information

Acknowledgements: This work was supported by the Public Health Agency of Canada. We wish to thank the British Columbia Centres for Disease Control, Valencia Remple, and the Medical Officers of Health for each participating health region (Drs. P. Daly (Vancouver Coastal Health Authority), J. Lu (Interior Health Authority) and L. Medd (Northern Health Authority)) for their support of this project.

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Edge, V.L., Odoi, A., Fyfe, M. et al. Physician Diagnostic and Reporting Practices for Gastrointestinal Illnesses in Three Health Regions of British Columbia. Can J Public Health 98, 306–310 (2007). https://doi.org/10.1007/BF03405409

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  • DOI: https://doi.org/10.1007/BF03405409

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