Article Figures & Data
Tables
- Table 1. Demographic details and clinical exposure and previous training or education in managing FI
Demographics n (%) Sex Male 221 (19.8) Female 894 (80.2) Practice location Metropolitan 650 (61.0) Regional 372 (34.9) Remote 44 (4.1) Specific area(s) of clinical interest Women’s Health 716 (64.0) Antenatal care 361 (32.3) Dermatology 208 (18.6) Aged care 178 (15.9) Paediatrics 397 (35.5) Other 201 (18.0) No specific area of clinical interest 232 (20.7) Clinical exposure, previous training , or education in managing FI Training or education received for FI management None 406 (32.0) Small amount 752 (59.3) Moderate amount 97 (7.6) Substantial amount 10 (0.8) Large amount 4 (0.3) Training or education received for UI management None 53 (4.2) Small amount 670 (52.5) Moderate amount 471 (36.9) Substantial amount 74 (5.8) Large amount 8 (0.6) Training or education received for managing ‘bowel problems’ None 129 (10.2) Small amount 609 (48.0) Moderate amount 442 (34.8) Substantial amount 81 (6.4) Large amount 9 (0.7) GP wishing to receive more training and/or education No 65 (5.1) Yes 1206 (94.9) By face-to-face lectures 606 (50.2) By online courses 502 (41.6) By reading material 325 (26.9) By DVD 175 (14.5) Totals for individual items may not equal 1285 owing to missing data. FI = faecal incontinence. UI = urinary incontinence.
Knowledge n (%) GP’s self-rated overall knowledge about FI Very poor 206 (16.2) Poor 679 (53.5) Reasonable (neither poor nor good) 365 (28.7) Good 17 (1.3) Very good 3 (0.2) GP’s estimation of FI prevalence in primary care <1% 60 (4.8) 1%–4% 457 (36.2) 5%–9% 406 (32.2) 10%–14% 217 (17.2) 15%–24% 100 (7.9) ≥25% 21 (1.7) Which investigation(s) GP would arrange to investigate FI Faecal occult blood testing 556 (43.8) Colonoscopy 825 (65.0) Abdominal X-ray 272 (21.4) Abdominal ultrasound 175 (13.8) Endoanal ultrasound 283 (22.3) Computed Tomography (CT) scan abdomen or pelvis 216 (17.0) Anal manometry 531 (41.8) Digital rectal examination 1003 (79.0) Skills GP’s self-rated overall skills in treating patients with FI Very poor 141 (11.1) Poor 713 (56.1) Reasonable (neither poor nor good) 396 (31.2) Good 19 (1.5) Very good 2 (0.2) GP’s self-rated confidence in initiating lifestyle or conservative measures for patients with FI Very poor 152 (12.0) Poor 288 (22.7) Reasonable (neither poor nor good) 320 (25.2) Good 408 (32.1) Very good 102 (8.0) GP’s self-rated confidence in prescribing medication(s) to treat FI Very poor 284 (22.3) Poor 369 (29.0) Reasonable (neither poor nor good) 324 (25.5) Good 267 (21.0) Very good 28 (2.2) Totals for individual items may not equal 1285 owing to missing data. FI = faecal incontinence.
Barriers to screening and treating patients with FI n (%) Insufficient skills 703 (56.1) FI not common or significant enough to justify enquiring with patient 95 (7.6) Concerns that patient may not be receptive to screening or intervention 378 (30.1) Insufficient time to screen or provide intervention 150 (12.0) Insufficient support from specialists 178 (14.2) Wish to avoid further referrals of patients with FI in the future 38 (3.0) Perception that FI has no effective treatment, so screening is futile 83 (6.6) Perception that FI is not the most important issue during the consultation 115 (9.2) Lack of interest in screening or treating FI 70 (5.6) GP’s embarrassment to ask patients about any bowel leakage 50 (4.0) Avoidance of patient’s embarrassment if probed about bowel leakage problems 113 (9.0) Perception that FI should only be treated by specialists in the field 76 (6.1) Facilitators to screening and treating patients with FI Knowing exactly who to refer to 1071 (84.6) Knowing exactly where to refer to 938 (74.1) Easier referral pathway 583 (46.1) More resources to assist 677 (53.5) Having effective treatments available 567 (44.8) Belief among GPs that screening and intervention are important 590 (46.6) Having more detailed communication from specialists after referral 609 (48.1) Having less detailed communication from specialists after referral 75 (5.9) Access to up-to-date management guidelines and recommendations 898 (70.9) Further training to allow GP to be more comfortable talking to patients about FI 570 (45.0) Further training to allow GP to be more knowledgeable treating FI 860 (67.9) No facilitators identified 42 (3.3) Totals for individual items may not equal 1285 owing to missing data. FI = faecal incontinence.
Confidence to initiate lifestyle or conservative measures Confidence to prescribe medications for FI Self-rated knowledge of surgical procedures for FI Very poor or poor Reasonable or very good OR (95% CI) Very poor or poor Reasonable or very good OR (95% CI) Very poor or poor Reasonable or very good OR (95% CI) Practice location Metropolitan 240 (65.6%) 402 (58.4%) 357 (64.3%) 286 (57.1%) 386 (63.7%) 252 (57.1%) Regional or remote 126 (34.4%) 287 (41.7%) 1.36 (1.04 to1.77)a 198 (35.7%) 215 (42.9%) 1.36 (1.06 to 1.74)a 220 (36.3%) 189 (42.9%) 1.32 (1.02 to 1.69)a Years in clinical practice ≤15 years 160 (58.8%) 258 (50.3%) 242 (57.9%) 176 (48.0%) 258 (57.1%) 157 (47.7%) >15 years 112 (41.2%) 255 (49.7%) 1.41 (1.05 to 1.90)a 176 (42.1%) 191 (52.0%) 1.49 (1.13 to 1.98)b 194 (42.9%) 172 (52.3%) 1.46 (1.10 to 1.94)b Special clinical interest None 95 (25.1%) 135 (18.5%) 0.68 (0.50 to 0.91)a 123 (21.4%) 107 (20.0%) 0.91 (0.68 to 1.22) 140 (22.3%) 88 (18.8%) 0.81 (0.60 to1.09) Women’s health 224 (59.1%) 484 (66.3%) 1.36 (1.05 to 1.76)a 370 (64.5%) 339 (63.3%) 0.95 (0.74 to 1.21) 391 (62.2%) 314 (67.0%) 1.23 (0.96 to 1.58) Antenatal care 126 (33.3%) 233 (31.9%) 0.94 (0.72 to 1.23) 193 (33.6%) 166 (31.0%) 0.89 (0.69 to 1.14) 203 (32.3%) 150 (32.0%) 0.99 (0.76 to 1.27) Dermatology 59 (15.6%) 148 (20.3%) 1.38 (0.99 to 1.92) 98 (17.1%) 109 (20.3%) 1.24 (0.92 to 1.68) 112 (17.8%) 93 (19.8%) 1.14 (0.84 to 1.55) Aged care 40 (10.6%) 138 (18.9%) 1.98 (1.36 to 2.88)c 74 (12.9%) 104 (19.4%) 1.63 (1.18 to 2.25)b 91 (14.5%) 85 (18.1%) 1.31 (0.95 to 1.81) Paediatrics 131 (34.6%) 262 (35.9%) 1.06 (0.82 to 1.37) 216 (37.6%) 178 (33.2%) 0.82 (0.64 to 1.05) 217 (34.5%) 175 (37.3%) 1.13 (0.88 to 1.45) Clinical exposure (percentage of workload comprising patients with FI) <5% 403 (92.2%) 711 (86.3%) 597 (92.1%) 519 (84.4%) 657 (92.2%) 449 (83.8%) ≥5% 34 (7.8%) 113 (13.7%) 1.88 (1.26 to 2.82)b 51 (7.9%) 96 (15.6%) 2.17 (1.51 to 3.10)c 56 (7.9%) 87 (16.2%) 2.27 (1.59 to 3.25)c Training or education in FI management None or small amount 418 (96.5%) 728 (88.5%) 619 (96.4%) 529 (85.9%) 681 (96.1%) 454 (84.9%) Moderate or large amount 15 (3.5%) 95 (11.5%) 3.64 (2.08 to 6.35)c 23 (3.6%) 87 (14.1%) 4.43 (2.76 to 7.11)c 28 (4.0%) 81 (15.1%) 4.34 (2.78 to 6.78)c a P<0.05; b P<0.01; c P<0.001. FI = faecal incontinence.
Supplementary Data
- BJGPO.2020.0182.pdf -
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Knowledge, skills, and barriers to management of faecal incontinence in Australian primary care: a cross-sectional study
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