Nurse-Led, Shared Medical Appointments for Common Gastrointestinal Conditions—Improving Outcomes Through Collaboration With Primary Care in the Medical Home: A Prospective Observational Study

Abstract

Background Gastroesophageal reflux disease (GERD), dyspepsia and irritable bowel syndrome (IBS) are common gastrointestinal disorders accounting for a significant demand for specialty care. The aim of this study was to evaluate safety, access and outcomes of patients assessed by a nurse-led, shared medical appointment. Methods This prospective observational study utilized a sample of 770 patients referred to a gastroenterology Central Access and Triage for routine GERD, dyspepsia or IBS from 2011 to 2014. Patient demographics, clinical indication, frequency and outcomes of endoscopy, quality of life, wait times and long-term outcomes (>2 years) were compared between 411 patients assigned to a nurse-led, shared medical appointment and 359 patients assigned to clinic for a gastroenterology physician consultation. Results The nurse-led, shared medical appointment pathway compared with usual care pathway had shorter median wait times (12.6 weeks versus 137.1 weeks, P < 0.0001), fewer endoscopic exams (50.9% versus 76.3%, P < 0.0001), less gastroenterology re-referrals (4.6% versus 15.6%, P < 0.0001), and reduced visits to the emergency department (6.1% versus 12.0%, P = 0.004). After two years of follow-up, outcomes were no different between the pathways. Conclusions Patients with GERD, IBS or dyspepsia who attend the nurse-led, shared medical appointment have improved access to care and reduced resource utilization without increased risk of significant gastrointestinal outcomes after two years of follow-up.

Diagnostic Accuracy of FIB-4 and FIB-5 Scores as Compared to Fibroscan for Assessment of Liver Fibrosis in Patients With Non-Alcoholic Fatty Liver Disease

“…The reports were validated by two experienced clinicians. The report of fibrosis was obtained in kPa and results were interpreted as follows [ 10 ]:…”

“…So fibroscan has the means to replace liver biopsy as the gold standard [ 7 ]. But it has limited availability, due to its exorbitant cost and need of skilled hands which restricts its frequent use for the follow-up of general population in developing countries like India [ 10 ].…”

Gastroscopy for dyspeptic symptoms in patients <65 years has a low yield of clinically important findings: a retrospective study

“… 35 , 39–42 To reduce low-value gastroscopy in dyspeptic patients, strategies like web-based patient education, physician audit and feedback, nurse-led shared appointments, referral filters, guideline adaptation and implementation, and decision-aids have been tried with varying success. 35 , 43 , 44 In Alberta, we do not have open-access gastroscopies. We have direct-to-procedure (DTP) bookings combining the consultation and gastroscopy at the same time.…”

Do Low-Risk Patients With Dyspepsia Need a Gastroscopy? Use of Gastroscopy for Otherwise Healthy Patients With Dyspepsia

“…Ideally, multidisciplinary care teams co-located in patient’s primary care medical home could be used to improve quality of life and symptom burden in patients negative for H. pylori and/ or nonresponders to PPI therapy. Managing dyspepsia in the medical home could lead to avoiding referral to specialty gastroenterologists who may have lengthy wait times and limited access ( 17 ). Such services may include nutrition support, stress management/behavior change consultants, even psychiatric and specialized nursing care ( Supplementary Appendix 2 ).…”