Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2017; 23(42): 7635-7643
Published online Nov 14, 2017. doi: 10.3748/wjg.v23.i42.7635
Predictors of healthcare-seeking behavior among Chinese patients with irritable bowel syndrome
Wen-Juan Fan, Dong Xu, Min Chang, Li-Ming Zhu, Gui-Jun Fei, Xiao-Qing Li, Xiu-Cai Fang
Wen-Juan Fan, Dong Xu, Min Chang, Li-Ming Zhu, Gui-Jun Fei, Xiao-Qing Li, Xiu-Cai Fang, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Dong Xu, Department of Gastroenterology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Author contributions: Fan WJ collected the data and wrote the manuscript; Xu D and Chang M collected the data; Zhu LM, Fei GJ and Li XQ consulted with the patients; Fang XC designed the study, consulted with the patients and critically revised the manuscript; all authors had final approval of the article.
Supported by the Program of International S&T Cooperation, No. 2014DFA31850; Project of the National Key Technologies R&D Program in the 11th Five Year Plan period, No. 2007BAI04B01; and National High-tech R&D Program (“863” Program, 2010AA023007), China.
Institutional review board statement: The observational study was approved by the Ethics Committee of Peking Union Medical College Hospital.
Informed consent statement: Parts of study participants provided informed written consent prior to study enrollment and other patients orally consented to participate the study after informed.
Conflict-of-interest statement: The authors of the manuscript have no conflicts of interest to disclose.
Data sharing statement: We have submitted an article “Analysis of symptomatic characteristics of patients with irritable bowel syndrome in China” with the same database to Chinese Journal of General Practitioners, which has been published on 2017, 16(9): 668-671.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiu-Cai Fang, MD, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1, Shuaifuyuan, Dongcheng District, Beijing 100730, China. fangxiucai2@aliyun.com
Telephone: +86-10-69156892 Fax: +86-10-69151963
Received: August 2, 2017
Peer-review started: August 4, 2017
First decision: August 30, 2017
Revised: September 13, 2017
Accepted: October 18, 2017
Article in press: October 19, 2017
Published online: November 14, 2017
Abstract
AIM

To analyze predictors of healthcare-seeking behavior among Chinese patients with irritable bowel syndrome (IBS) and their satisfaction with medical care.

METHODS

Participating patients met IBS Rome III criteria (excluding those with organic diseases) and were enrolled in an IBS database in a tertiary university hospital. Participants completed IBS questionnaires in face-to-face interviews. The questionnaires covered intestinal and extra-intestinal symptoms, medical consultations, colonoscopy, medications, and self-reported response to medications during the whole disease course and in the past year. Univariate associations and multivariate logistic regression were used to identify predictors for frequent healthcare-seeking behavior (≥ 3 times/year), frequent colonoscopies (≥ 2 times/year), long-term medications, and poor satisfaction with medical care.

RESULTS

In total, 516 patients (293 males, 223 females) were included. Participants’ average age was 43.2 ± 11.8 years. Before study enrollment, 55.2% had received medical consultations for IBS symptoms. Ordinary abdominal pain/discomfort (non-defecation) was an independent predictor for healthcare-seeking behavior (OR = 2.07, 95%CI: 1.31-3.27). Frequent colonoscopies were reported by 14.7% of patients (3.1 ± 1.4 times per year). Sensation of incomplete evacuation was an independent predictor for frequent colonoscopies (OR = 2.76, 95%CI: 1.35-5.67). During the whole disease course, 89% of patients took medications for IBS symptoms, and 14.7% reported they were satisfied with medical care. Patients with anxiety were more likely to report dissatisfaction with medical care (OR = 2.08, 95%CI: 1.20-3.59). In the past year, patients with severe (OR = 1.74, 95%CI: 1.06-2.82) and persistent (OR = 1.66, 95%CI: 1.01-2.72) IBS symptoms sought medical care more frequently.

CONCLUSION

Chinese patients with IBS present high rates of frequent healthcare-seeking behavior, colonoscopies, and medications, and low satisfaction with medical care. Intestinal symptoms are major predictors for healthcare-seeking behavior.

Keywords: Irritable bowel syndrome, Colonoscopy, Healthcare seeking, Treatment, Outcomes

Core tip: The prevalence of irritable bowel syndrome (IBS) in the general Chinese population is about 6.5%. Many patients are dissatisfied with the efficacy of traditional IBS treatments. Data about healthcare-seeking behavior among these patients in China are lacking. We analyzed a database of patients with IBS from Peking Union Medical College Hospital to identify predictors for healthcare-seeking behavior and satisfaction with medical care among this population. We found high rates of frequent healthcare-seeking behavior, colonoscopies, and medications, and low satisfaction with medical care. Intestinal symptoms were major predictors for healthcare-seeking behavior. Anxiety influenced satisfaction with medical care.