title: Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation.
abstract: BACKGROUND
  The role of psychological factors in irritable bowel syndrome (IBS) remains unclear, particularly in a primary care setting, where relatively little research on this common and costly condition has been carried out. The aim of this study was to investigate the relative contribution of physical and psychological factors to health-related quality of life and health-care utilization in patients with functional bowel disease (IBS-like symptoms) in primary care. We also wished to establish the relevance of formal diagnostic criteria to IBS in the primary care setting.
  
  
  METHODS
  This study used a cross-sectional design. Four hundred twenty patients with functional bowel disorders in primary care completed a series of measures, including bowel symptom status and severity, severity of psychological distress, personality, and quality of life. The number of visits to a general practitioner (GP) in the previous 12 months was recorded.
  
  
  RESULTS
  The following variables were independently and highly significantly associated with health-related quality of life in patients with functional bowel disorders in primary care: total psychological symptom score, diarrhea severity, abdominal pain for >12 weeks, and abdominal distension. A similar pattern emerged between patients who met meet Rome II criteria for IBS and patients who did not meet Rome II criteria for IBS. Relatively few variables (either physical or psychological) had a major impact on the number of GP consultations, with the exception of frequency of bowel movements.
  
  
  CONCLUSIONS
  This study confirms that psychological factors are significantly associated with health-related quality of life in patients with IBS in primary care. Physical symptom severity is also important. Relatively few symptom measures, either physical or psychological, have a major impact on doctor consultation rates in primary care.
authors.affiliation: National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lee
authors.forename: Else
authors.initials: E
authors.lastname: Guthrie
authors.forename: Andrew
authors.initials: A
authors.lastname: Robinson
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: David
authors.initials: D
authors.lastname: Thompson
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011788:Quality of Life / Q000523:psychology*; D012017:Referral and Consultation; D012648:Self Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires