Production and evaluation of guidelines for the management of inflammatory bowel disease: the Leicester experience
A M Reada, M A Stonea, B J Rathboneb, J de Caesteckerc, A C B Wicksa, S Longworthd, C R O'Sheae, R Bakerf, D Spencea, A W Hallc, M J Kellya, J Cannona, R J Robinsona, A R Harta, P Milesa, J F Mayberrya
a Leicester General
Hospital, Leicester LE5 4PW, UK, b Leicester Royal Infirmary, Infirmary
Square, Leicester LE1 5WW, UK, c Glenfield Hospital, Groby Road, Leicester LE3
9QP, UK, d Uppingham
Road Surgery, Leicester LE5 4BP, UK, e Latham House Surgery, Sage Cross Street, Melton
Mowbray, LE13 1NX, UK, f Eli
Lilly National Clinical Audit Centre, Gwendolen Road, Leicester LE5
4PW, UK
Correspondence to: Dr John F Mayberry, Chairman, Leicester Gastroenterology Guidelines Committee, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
Accepted 30 October
1998
Consensus guidelines for the management of patients with
inflammatory bowel disease were produced by gastroenterologists, gastrointestinal surgeons and a cross-section of general practitioners (GPs) from Leicestershire in order to develop a seamless pattern of
care with a common approach to diagnosis and treatment. It was hoped
that the guidelines would encourage a movement towards care in the
community for many patients with stable disease and so speed up new
consultation rates. The study then assessed the impact of these
guidelines on the referral letters of GPs to hospital consultants, the
prediction of disease and adherence to them on re-referring patients
after discharge. The guidelines were distributed to all 487 GPs in the
Leicester Health Authority area and the gastroenterology teams within
the hospitals. The value of the guidelines was assessed by an audit of
referral letters, the length of time from referral letter to
out-patient appointment, both before and after the launch of the
guidelines, adherence to the guidelines on re-referral, and monitoring
the outcome of the discharged patients. Whilst the guidelines may have
helped GPs to manage stable patients in the community, the content of
referral letters and the diagnostic abilities of GPs were not seen to
improve since the launch of the guidelines. However, only 5% of stable
patients who were discharged from one clinic were re-referred for
inflammatory bowel disease.
Keywords: guidelines; audit; inflammatory bowel disease
© 1999 by The Fellowship of Postgraduate Medicine
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