Study Finds Physicians Ignore Behavioral Therapy Referral Standards for IBS Management

Recognizing frustrations stemming from "the contested nature of the diagnosis, ineffective treatments, and a mismatch between general practitioner (GP) and patient explanatory models" for irritable bowel syndrome, a team of British researchers examined the tensions between how physicians approach IBS and what's currently recommended for diagnosing and managing the functional gastrointestinal disorder.

Recognizing frustrations stemming from “the contested nature of the diagnosis, ineffective treatments, and a mismatch between general practitioner (GP) and patient explanatory models” for irritable bowel syndrome, a team of British researchers examined the tensions between how physicians approach IBS and what’s currently recommended for diagnosing and managing the functional gastrointestinal disorder.

For their “GP Perspectives of Irritable Bowel Syndrome: An Accepted Illness, But Management Deviates from Guidelines” study published in the June 2013 issue of BMC Family Practice, Elaine F. Harkness from the University of Manchester and colleagues interviewed 19 general practitioners to establish their “views on the etiology of IBS, how they make the diagnosis of IBS and explain this to patients, (and) treatments offered to patients” during day-to-day clinical practice.

Comparing those responses to the National Institute for Health and Care Excellence (NICE)’s evidence-based guidelines for IBS management, the authors discovered that although the physicians “accepted there was a link between IBS and psychological symptoms, they suggested that the majority of patients could be managed within primary care without referral for psychological interventions,” which is against the NICE recommendation for cognitive behavioral therapy and hypnotherapy in IBS patients.

Additionally, in cases where IBS patients sought “a bit of homeopathy” such as acupuncture and reflexology to manage their chronic symptoms, the general practitioners either applied, encouraged, or did not discourage that approach, all of which are also not advocated by the NICE standards. Furthermore, “the NICE guideline recommends annual review of patients with IBS, but no GPs reported offering this,” the authors wrote.

According to the researchers, the conflicts between the physicians and the guidelines “may have implications for commissioning services and patient care” — especially for IBS patients who could benefit from psychological interventions, but do not receive referrals to receive those treatments.