Improving Management in Gastroenterology (IMAGE) CORE: The Digestive Orders Foundation

This project sought to address a lack of criteria for good management of gastrointestinal problems in the Quality and Outcomes Framework targets. It aimed to develop targets equivalent to those already available for managing chronic diseases such as diabetes, and heart disease.

It focused on developing evidence-based guidelines for four gastrointestinal disorders and incorporating them into GPs’ computer systems. The disorders were: reflux disease; irritable bowel syndrome (IBS); inflammatory bowel disease (IBD); and coeliac disease.

A priority for the team was to ensure that guidelines incorporated the patient’s point of view. Around 100 patients took part in focus groups at GP practices across England. In total more than 1,000 patients participated in the study, which involved 39 practices.

Focus groups highlighted patients’ issues and concerns including:

• delays in diagnosis
• variations in services and access to professionals such as dieticians and specialist nurses
• poor relationships with secondary care.

GPs were also involved in reviewing existing evidence and guidance, and incorporating the patients’ perspectives into new treatment protocols. GPs then started using the protocols and computerised prompts and guidelines in their consultations.

Benefits

As well creating a quality criteria for submission to the Quality and Outcomes Framework and NICE, the project team reported:

• modest, positive improvements in patient-related outcomes across all four conditions.
• developing computer generated prompts to remind GPs about particular steps that they ought to be taking to better manage patient care
• using their findings to influence practice-based commissioning.

Who was involved?

The work was supported by GP ‘gastrochampions’ in each site, by an advisory board, and by close involvement from NACC, Coeliac UK, the Gut Trust, and CORE. Partners included King’s College, University of London, Primary Care Society for Gastroenterology, British Society of Gastroenterology and University of Oxford.