General practitioners (GPs) regularly see children with chronic abdominal complaints. The GP faces the challenge of recognizing and referring rare, serious conditions on time. At the same time, it is important that children with functional gastrointestinal disorders are not too frequently subjected to diagnostic tests and referrals, as this can maintain complaints and lead to unnecessary costs. In this dissertation, Sophie Ansems investigated how we can assist GPs with this challenge.
General practice records showed that GPs relatively often perform medical interventions for these children, such as diagnostic testing (one in three), medication (one in three), and hospital referral (one in six). A referral strategy guided by testing calprotectin in the stool could help GPs referring fewer children. In a randomized controlled trial, this strategy was compared to standard care. The strategy was only (cost-) effective when GPs followed all the recommended test and referral steps. However, they did so in only six out of ten children. A possible explanation is that GPs also used medical interventions for other purposes, such as improving the doctor-patient relationship. Before the strategy is incorporated into guidelines, research is needed on how to ensure that GPs follow all strategy steps.
Interviews revealed that parents are primarily seeking acknowledgement, reassurance, and an explanation for the complaints, while GPs especially struggle with reassuring and treating children with functional abdominal complaints. Further research into communication tools and primary care treatments may therefore improve the care for children with chronic abdominal complaints.
