Awareness and Practice Patterns of Celiac Disease Among Family Physicians: A Questionnaire-Based Study in Relation to Years in Practice and Awareness of Local Guidelines

Year 2020, Volume: 11 Issue: 40, 60 - 65, 30.08.2020

Nimet Yılmaz

https://doi.org/10.17944/mkutfd.664614

Abstract

Objective: To evaluate awareness and practice patterns of family physiciansregarding celiac disease (CD), in relation to years in practice and awareness of local guidelines
Methods: A total of 147 family physicians (mean age 39.4 years, range, 24 to 64 years and 52.4% were female) working in primary care clinics across Gaziantep province were included on a voluntary basis in this cross-sectional questionnaire-survey. The questionnaire form elicited items on sociodemographic characteristics of physicians (age, gender, years in practice), their awareness of CD (serological tests, screening indications, types of the disease) and practice patterns in CD including frequency of suspected diagnosis, serological tests, intestinal biopsy, risk of malignancy, gluten-free diet strictness and criteria, IgA screening and awareness of local guidelines. The questionnaire form was applied via face-to-face interview method.
Results: Presence of chronic diarrhea (33.7%) was reported to be the most indication for serological analysis and typical form of the disease (49.8%) was reported to be more commonly recognized. Only 17.7% of physicians reported that they frequently suspect CD in adult patients, 38.1% reported that they frequently refer patients for serological tests for CD and 36.1% reported that they always recommend intestinal biopsy for serology positive patients. Overall, 63.5% of physicians considered strict the gluten-free diet to always be applied by patients with CD, 51% reported that they recommend a gluten-free diet to serology negative patient with symptoms similar to CD and 19.7% reported that they recommend IgA screening for patients with CD. No significant difference was noted in practice pattern variables with respect to years in practice, while the likelihood of a physician to always recommend intestinal biopsy for serology positive patients (42.7% vs. 27.7%, p=0.028) significantly increased with the awareness of guidelines.
Conclusion: In conclusion, our findings indicate low level of awareness about CD in terms of adult-onset and atypical presentations and poor knowledge regarding the diagnosis and practice patterns in CD among family physicians, regardless of the years in practice. Accordingly, our findings indicate a need to increase awareness of CD and improve adherence to guidelines via educational sessions and workshops among family physicians, particularly in terms of the recognition of adult onset of symptoms, the utility of serological tests combined with intestinal biopsy and proper recommendation of gluten-free diet in individuals with CD.

Keywords

Celiac disease, family care physicians, Awareness

Aile Hekimleri Arasında Çölyak Hastalığı Farkındalığı ve Pratik Modelleri: Meslek Yıllarına ve Yerel Kılavuzların Farkındalığına İlişkin Anket Tabanlı Bir Çalışma

Abstract

Amaç: Aile hekimlerinin çölyak hastalığı (ÇH) ile ilgili farkındalık ve klinik pratikleri, mesleki yıllara ve yerel klavuzların farkındalığına göre değerlendirmek.
Yöntemler: Gaziantep’teki birinci basamak kliniklerinde çalışan toplam 147 aile hekimi bu kesitsel ankete gönüllü olarak dahil edildi. Anket formunda hekimlerin sosyodemografik özellikleri, ÇH farkındalıkları (serolojik testler, tarama endikasyonları, hastalık tipleri) ve ÇH’dan şüphelenme sıklığı, bağırsak biyopsisi, malignite riski, glutensiz diyet katılığı ve kriterleri, IgA taraması ve yerel kılavuzlar hakkında farkındalıkları sorgulandı. Anket formu yüz yüze görüşme yöntemi ile uygulanmıştır.
Bulgular: Serolojik analiz için en fazla endikasyonun kronik ishal varlığı (%33,7) ve hastalığın tipik formunun (%49,8) daha yaygın olarak tanındığı bildirilmiştir. Hekimlerin sadece %17,7’si erişkin hastalarda sıklıkla ÇH’dan şüphelendiklerini, % 38.1’i sık sık hastaları ÇH için serolojik testlere sevk ettiklerini ve % 36.1’i seroloji pozitif hastalar için her zaman bağırsak biyopsisi önerdiklerini bildirmiştir. Genel olarak, hekimlerin %63,5’i katı glutensiz diyetin ÇH’da daima uygulanması gerektiğini düşünmektedir. %51’i ÇH’na benzer semptomları olup seroloji negatif hastalarına glutensiz bir diyet önerdiklerini ve %19,7’si ÇH’da IgA taraması önerdiklerini bildirmiştir. Bir doktorun seroloji pozitif hastalar için bağırsak biyopsisini her zaman önerme olasılığı (42.7% vs. 27.7%, p=0.028) kılavuzların farkında olmasıyla önemli ölçüde artmıştır.
Sonuç: Bulgularımız, erişkin başlangıçlı ve atipik semptomlar konusunda ÇH hakkında düşük düzeyde farkındalık ve mesleki yıllara bakılmaksızın aile hekimleri arasında ÇH’da tanı ve takip hakkında yetersiz bilgi olduğunu göstermektedir. Buna göre, bulgularımız, özellikle yetişkinlerde semptomların tanınması, bağırsak biyopsisi ile kombine serolojik testlerin kullanımı ve uygun öneriler açısından, aile hekimleri arasında eğitim toplantıları ve çalıştaylar yoluyla ÇH farkındalığını artırma ve kılavuzlara daha fazla uyma ihtiyacını göstermektedir.

Keywords

Çölyak Hastalığı, Aile Hekimi, Farkındalık

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