PWE-165 A Real World Study To Describe The Patient Pathways And Nhs Resource Use Associated With The Management Of Irritable Bowel Syndrome (ibs) In Uk Clinical Practice

Abstract

Introduction Irritable bowel syndrome (IBS) is often a diagnosis of exclusion, with poor diagnosis coding in primary care. This makes identification of eligible research participants challenging. We present the methodology development of a multi-centre, observational, retrospective research study ongoing in primary care, designed to overcome the challenges of IBS patient identification. Methods Study feasibility was conducted by pH Associates (research consultancy; study coordinators) for Almirall UK Ltd (Sponsor) using medical opinion, clinical coding searches and NIHR Clinical Research Network expertise. FARSITE, a software tool for identification of research participants in primary care developed by the Greater Manchester Comprehensive Local Research Network and North West e-Health, was used to screen anonymised primary care records for potential eligible patients. Search criteria: patients aged 18-60; combination READ code symptoms indicative of IBS and prescription of IBS drugs 01/01/2009-31/12/2011. GP practices with eligible patients were invited to participate, with GPs reviewing clinical records of the FARSITE-generated list of patients to apply full eligibility criteria for final patient selection. Inclusion criteria: medical diagnosis of IBS or meeting ROME III criteria; provision of consent. Exclusion Criteria: diagnosis excluding IBS; IBS symptoms secondary to other condition; IBS medications for non-GI symptoms. The study is ongoing in 8 GP practices in Salford and Greater Manchester (Ethical approval 13/LO/0692). Results FARSITE feasibility search using READ code for IBS identified 50 (0.02%) patients. Combining READ codes with symptom and prescriptions criteria selected 4714 (1.9%) From these, 3 GP practices each screened 10 random patient records for eligibility and 12/30 (40%) were found eligible. Eligibility READ codes were revised following feasibility. Following study approvals, FARSITE identified 1089 potential eligible patients at the 8 participating practices, of which 297 (27.3%) were eligible and approached for consent for participation. Main reasons for non-eligibility were symptom characteristics not meeting ROME III criteria or not confirmed as IBS by medical opinion. Conclusion Identification of patients with IBS using READ code is sub-optimal in primary care. A combination search of READ codes with symptom and prescription data via FARSITE has enabled potential participants to be identified with a reasonable screening failure rate. FARSITE is a valuable research tool aiding study feasibility by reducing the need for manual patient identification.