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CLINICAL: CHRONIC ILLNESS Jenny Gough


FFPH MPH RGN RHV CPT BTEC Dip Counselling OND Deputy Director of Public Health


NHS North Central London Camden Public Health University of Chester


Irritable bowel syndrome in adults: best practice for primary


healthcare professionals Many sufferers rely on self-care to cope with their symptoms. For those presenting in primary care, there are a number of management strategies


I


rritable bowel syndrome (IBS) is a chronic relapsing and often lifelong disorder. It is characterised by the presence of abdominal pain associated with defaecation, or a change in bowel habit, together with disordered defaecation (constipation or diarrhoea or both) and the sensation of abdominal distension. Healthcare profes- sionals need to be aware that symptoms sometimes


overlap with other gastrointestinal disorders, such as non-ulcer dyspepsia, or with coeliac disease. Diagnosis of IBS has proven difficult historically for many reasons, not least that traditionally an exclusion diagnostic approach has been selected by clinicians.1


NICE Guidance relating to IBS and all care documented in the patients records. There should be an integrated approach to the diagnosis and management of IBS in Primary Care with a clear strategy and policy, supported by all partners. The healthcare team should have received appropriate training and updates in order to be able to demonstrate their compe- tence in diagnosing and managing IBS.


Each


year, typically 10% of the population will experience IBS symptoms, with up to half of these presenting to primary care clinicians. This article will aim to demonstrate the importance of the


support primary healthcare practitioners can give to patients diagnosed with IBS and their families in order to improve their quality of life and be able to maintain as normal a life as is possible. It is not intended to be an academic paper, but a guide to enable healthcare professionals to recognise and support their patients in a Primary Care setting.


KEY PRIORITIES FOR PRIMARY CARE: PREVENTION, DIAGNOSIS AND MANAGEMENT NICE clinical guidelines2


support the role of healthcare profession-


als in providing care in partnership with patients, taking into account their individual needs and preferences and ensuring that patients, their carers and families (where appropriate) can make informed decisions about their care and treatment. Healthcare professionals should readily acknowledge and incorporate the experience of patients who have been self-managing their condition. Many of these patients will have been self-medicating for a number of years in order to control their symptoms.


ORGANISATIONAL ISSUES All members of the interdisciplinary team should be aware of


QUALITY OF LIFE Chronic illness remains a significant challenge to the individual in terms of effective coping, and to the NHS in terms of identifying the appropriate level of support to that individual and their family, particularly in a primary care setting. Quality of life issues are constantly raised with patients with


IBS, as the level of impact on daily living is paramount. Patients often express the desire to be offered a cure and information on long-term prognosis, which reflects the over-medicalised language used in relation to effective coping. Living with IBS is the challenge for the patient, and symptom-based management relating to the quality of life experience is key in the shared model, and is ‘best practice’ for healthcare professionals. An example of this would be working in partnership with the patient, carer and/or family, as this can affect them all. In the Lacy study,3


nearly all participants


(n=261) reported that IBS affected their lives in some way. Clearly, this relates to severity and quality of life when considered as a continuum, and one can see the patient shifting from coping to not coping, which reflects the episodic nature of the syndrome. The unpredictability of IBS is one of the biggest challenges for both patient and healthcare professional. There is fair evidence indicating that if patients with IBS receive


directed information and encouragement to be actively involved in the management of their condition that this contributes to: A positive impact on treatment outcomes. An improvement in quality of life perception and reduction in


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