Healthcare Utilisation of Patients with Cholecystolithiasis in Primary Care: a Multipractice Comparative Analysis

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 Nov 4

PMID 34732495

Citations 4

Authors

Floris Martijn Thunnissen

Luuk David Drager

Breg Braak

Joost P H Drenth

Cornelis J H M van Laarhoven

Henk J Schers

Philip R de Reuver

Affiliations

Soon will be listed here.

Abstract

Objectives: To examine general practitioners' (GP) management of cholecystolithiasis and to evaluate persisting abdominal complaints in the years after the diagnosis.

Design: Retrospective analysis of registry data and a subset of individual medical records.

Setting: Seventeen primary care practices affiliated with the Radboudumc Practice Based Research Network in the Netherlands.

Participants: 633 patients with cholecystolithiasis diagnosed between 2012 and 2016.

Primary And Secondary Outcome Measures: The primary outcome of this study was the healthcare utilisation of patients with cholecystolithiasis diagnosed by the GP in terms of referrals to secondary care, laboratory diagnostics, prescribed medication and the prevalence of concomitant abdominal-related diagnoses in a time interval of 3 years before and 3 years after diagnosis of cholecystolithiasis. For secondary outcomes, electronic medical records were studied from seven practices to assess emergency department visits, operation rates and repeat visits for persistent abdominal symptoms. We compared the non-referred group with the referred group.

Results: In 57% of patients, concomitant abdominal-related diagnoses were recorded besides the diagnosis cholecystolithiasis. In-depth analyses of 294 patients showed a referral rate of 79.3% (n=233); 62.9% (n=185) underwent cholecystectomy. After referral, 55.4% (129/233) returned to the GP for persistent abdominal symptoms. Patients returning after referral were more often treated for another abdominal-related diagnosis before cholecystolithiasis was recorded (51.9% vs 28.8%, p<0.001).

Conclusions: The majority of patients in general practice with gallstones are referred and undergo cholecystectomy. Patients with concomitant abdominal-related diagnoses are likely to return to their physician. GPs should inform patients about these outcomes to improve the shared decision-making process before gallbladder surgery.

Citing Articles

Features of Metabolite Changes in Disease Evolution in Cholecystolithiasis.

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Patients with Clinically Suspected Gallstone Disease: A More Selective Ultrasound May Improve Treatment Related Outcomes.

Thunnissen F, Comes D, Geenen R, Riviere D, Latenstein C, Lantinga M J Clin Med. 2023; 12(12).

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Tailoring diagnosis and treatment in symptomatic gallstone disease.

Latenstein C, de Reuver P Br J Surg. 2022; 109(9):832-838.

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