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
Processing time: 102 Days and 6 Hours
ARTICLE HIGHLIGHTS
Research background

Irritable bowel syndrome (IBS) is a chronic recurrent functional bowel disorder which impairs patients’ quality of life. Patients with IBS report poor treatment response and satisfaction rates for traditional treatments and undergo frequent consultations and referrals. In China, data for predictors of healthcare-seeking behavior and satisfaction with medical care are lacking. Studies regarding predictors for healthcare-seeking behavior among patients with IBS may provide evidence for IBS management strategies in this region.

Research motivation

The present study comprehensively summarized the characteristics of healthcare-seeking behavior, medical costs, and satisfaction with care among Chinese patients with IBS. The authors also investigated predictors for frequent consultations, frequent colonoscopies, dissatisfaction with medical care, and long-term and multiple medications among Chinese patients with IBS. The authors’ study provides a basis for future studies on healthcare-seeking behavior among patients with IBS, and may provide management guidance for clinicians.

Research objectives

The main objectives of this study were to investigate the characteristics of healthcare-seeking behavior, medical costs, and satisfaction with care among Chinese patients with IBS, and determine predictors for frequent consultations, frequent colonoscopies, dissatisfaction with medical care, and long-term and multiple medications in this population.

Research methods

The authors enrolled patients with IBS who met Rome III diagnostic criteria and excluded organic diseases in a tertiary gastroenterology clinic from 2009 to 2016. Patients were administered IBS questionnaires in face-to-face interviews, which included intestinal and extra-intestinal symptoms, medical consultations and management. Data were collected and analyzed with SPSS version 19.0 software. Patients were divided into frequent consulters and infrequent consulters; frequent colonoscopies and infrequent colonoscopies; long-term medications and intermittent medications; medications ≥ 3 kinds and medications < 3 kinds; satisfaction with medical care and dissatisfaction with medical care. Univariate analysis was conducted with χ2 test to detect factors with significant differences between groups and the significant different factors above were entered into a multivariate logistic regression model to determine independent predictors for their healthcare-seeking behavior.

Research results

The authors found Chinese IBS patient present high rates of frequent healthcare- seeking behavior, colonoscopies, medications and low satisfaction with medical care. Abdominal pain/discomfort during non-defecation period (ordinary abdominal pain/discomfort) instead of pre-defecation abdominal pain/discomfort was the independent predictor for their healthcare-seeking behavior. Sensation of incomplete evacuation was the independent predictor for frequent colonoscopies. Patients with anxiety were more likely to report “dissatisfaction to medical care”. In the past year, patients with severe and persistent IBS symptoms sought medical care frequently. How to educate patients and obtain reasonable utilization of medical resources need to be solved.

Research conclusions

The results demonstrated that most patients with IBS were partially responsive to traditional treatment. Intestinal symptoms were major predictors for healthcare-seeking behavior, and patients with anxiety were more likely to be dissatisfied with medical care. The authors’ results provided guidance for Chinese IBS management. Doctors should pay attention to patients with specific symptoms such as ordinary abdominal pain/discomfort and anxiety.

Research perspectives

From the study, The authors learned that patients with IBS tended to undergo frequent consultations and investigations. Physicians should give patients sufficient explanations and pay attention to their psychological status. Future researches might emphasize the reasons of low effective rate of routine treatments and investigate the efficacy of psychological treatment through prospective studies.