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Determinants of Healthcare-Seeking Behaviour in IBS
      06/04/06 11:48 AM
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Determinants of Healthcare-Seeking Behaviour in IBS

From Alimentary Pharmacology & Therapeutics

R. E. Williams,* C. L. Black, H.-Y. Kim, E. B. Andrews, A. W. Mangel, J. J. Buda, & S. F. Cook,*

Aliment Pharmacol Ther. 2006;23(11):1667-1675. 2006 Blackwell Publishing

Discussion
Our finding that 49% of IBS subjects in our sample had sought medical care for abdominal symptoms in the past year is higher than previous US population-based studies, which report consultation rates for IBS symptoms in the past 12 months of 14-25%.[1, 11, 19] However, our study likely represents a subset of IBS patients with more severe disease because the study design necessitated that all subjects fulfil a modified version of the Rome II criteria for a period of at least 2 years. We found that females were more likely than males to receive a diagnosis of IBS by a doctor despite the fact that males sought medical care for their abdominal symptoms more frequently than females. This finding has not been previously reported in the literature and is in contrast to a report by Borum,[20] who conducted a survey of internal medicine doctors and found that doctors perceive IBS as easier to diagnose in men than in women. Several researchers have reported that the Manning and Rome criteria are less sensitive in diagnosing IBS in men than in women,[21, 22] but our results show that doctors are less likely to diagnose IBS in men than in women even when the men have abdominal symptoms which fulfil criteria for IBS.

More than half (55%) of subjects that had sought health care in the past year reported that the purpose of their most recent doctor visit was to get treatment for symptoms because previous treatment was unsatisfactory. Patient dissatisfaction with IBS therapy is consistent with several recent literature reviews of IBS treatment, which found limited or no evidence for the efficacy of current IBS medications, with the possible exception of the newer serotenergic agents, which are currently only approved for use in a small subset of patients with IBS.[23-25]

While abdominal pain or discomfort was the most common reason for seeking care among the healthcare seekers in our study, the severity of abdominal pain was not significantly different between the healthcare seekers and those that did not seek health care for their IBS. Other studies have reported an association between the frequency and/or severity of abdominal pain and healthcare-seeking behaviour,[1, 5-11] but we likely did not find an association in our study because all subjects must have experienced some degree of abdominal pain in order to meet our criteria for IBS and must have experienced this symptom for at least 2 years in order to be included in the study.

While a few studies have reported symptoms other than abdominal pain such as bloating,[9, 10] mucus per rectum, urgency, incomplete evacuation[9] and diarrhoea[5, 9] to be associated with seeking health care for IBS, we evaluated numerous abdominal symptoms and found associations only with decreased bowel movements in females and abdominal cramping in males.

Although we found differences in males and females regarding specific factors motivating healthcare-seeking behaviour, our results in both sexes are consistent with the finding that the presence of medical conditions in addition to IBS is associated with seeking health care for IBS symptoms. Females suffering from dyspepsia and pelvic pain were more likely to seek health care for IBS than subjects without these comorbid conditions. In contrast to several other studies that did not report an association between age and healthcare-seeking behaviour,[1, 6, 9] we found that older females were more likely to seek medical care for IBS than younger females. This is probably because older subjects are more likely to suffer from comorbid conditions that we did not measure, such as hypertension or cancer, which put them in frequent contact with the medical system. Because we limited our original cohort to individuals between the ages of 18 and 65 years, we could not evaluate healthcare-seeking behaviour above our age limits. In men, having a working status of disabled is along a similar vain, as the disabling condition also likely causes the subject to have frequent medical visits.

Earlier studies of healthcare-seeking behaviour and IBS concluded that symptoms of psychological distress are unrelated to IBS, but influence which patients will seek medical care for the condition.[4, 5] Our results are contrary to this finding. In a previous analysis, we found that subjects that continued to have IBS over a 2-year period had more psychological impairment that subjects that did not continue to have IBS during the follow-up period.[26] However, among those subjects that continued to meet the IBS criteria there was no difference in mental health status between healthcare seekers and healthcare non-seekers. Other recent studies have also found no association between psychological morbidity and seeking health care for IBS.[6, 27]

While we did not find an association with mental illness, we did find that the extent to which the subjects' IBS affected their physical and social functioning, as reflected in the IBSQOL scores, was important in distinguishing between those subjects that sought medical care for their IBS symptoms and those that did not. Greater interference of gastrointestinal symptoms with work and activities[6] and reduced IBS-specific quality of life[12] have previously been identified as predictors of health care use among IBS subjects. In our study, quality of life issues had a greater impact on the healthcare-seeking behaviour of males than that of females.

Among females in our study, healthcare seeking was related to worry that their abdominal symptoms were related to cancer or other serious illness. Gick and Thompson[28] found that healthcare seeking among IBS subjects was associated with concern about the meaning of IBS symptoms but not anxiety trait in general. This is consistent with our finding that healthcare seekers were more likely than non-seekers to have anxiety regarding their IBS symptoms but not psychological dysfunction otherwise. Other studies have reported concern about the serious nature of their symptoms[10] and anxiety about abdominal pain[29] to be more prevalent in healthcare seekers than non-seekers, but these studies also report greater levels of psychological distress among healthcare seekers. The latter study included patients with all functional gastrointestinal disorders, not solely IBS.

In conclusion, we found that healthcare-seeking behaviour among IBS subjects were determined by the presence of comorbid medical conditions and the extent to which their IBS symptoms affected their physical and mental well-being rather than by the nature of their physical symptoms or any underlying psychological morbidity.




http://www.medscape.com/viewarticle/532484_1

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