title: A comparison of irritable bowel syndrome patients managed in primary and secondary care: the Episode IBS study.
abstract: BACKGROUND
  It is thought that people with irritable bowel syndrome (IBS) who consult secondary care have more severe symptomatology than those treated mainly in primary care.
  
  
  OBJECTIVE
  To describe the physical and psychological symptoms of IBS, and the health-related quality of life of patients managed in primary and secondary care.
  
  
  METHODS
  Cross-sectional observational survey.
  
  
  METHODS
  The general population of the United Kingdom (UK).
  
  
  METHODS
  A cohort of people with IBS symptoms was recruited via a UK-wide newspaper advertisement. Frequency, duration and severity of symptoms, and health-related quality of life data were collected by semi-structured telephone interviews. Descriptive analysis allowed the comparison of those managed in primary care with those consulting secondary care. Logistic regression was used to identify factors associated with patients consulting secondary care.
  
  
  RESULTS
  Data on 486 participants with confirmed IBS (Rome II criteria) were examined. Similar patterns in symptom severity were found in primary and secondary care groups. Factors associated with IBS patients consulting secondary care were: male sex, a longer length of time since diagnosis, having frequent bowel motions, not having dyspepsia in the past 3 months, and having used medication and alternative therapies. Although patients managed in secondary care have greater impairment to their usual activities, both groups had similar health-related quality-of-life profiles.
  
  
  CONCLUSIONS
  High levels of physical and psychological morbidity were present in population-based volunteers managed in both primary and secondary care. This study suggests that patients with IBS managed solely in primary care are affected as much as those attending secondary care.
authors.affiliation: Centre for Mathematics and Statistics, Napier University, Edinburgh, Scotland. graeme.smith@ed.ac.uk
authors.forename: Graeme D
authors.initials: GD
authors.lastname: Smith
authors.forename: Douglas T
authors.initials: DT
authors.lastname: Steinke
authors.forename: Moira
authors.initials: M
authors.lastname: Kinnear
authors.forename: Kay I
authors.initials: KI
authors.lastname: Penny
authors.forename: Nim
authors.initials: N
authors.lastname: Pathmanathan
authors.forename: Ian D
authors.initials: ID
authors.lastname: Penman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000628:therapy*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012044:Regression Analysis