title: Using best practice to create a pathway to improve management of irritable bowel syndrome: aiming for timely diagnosis, effective treatment and equitable care.
abstract: BACKGROUND
  Irritable bowel syndrome (IBS) costs the National Health Service almost £12 million per annum. Despite national guidelines advising primary care management, these have failed to stem secondary care referrals of patients with likely IBS for unnecessary and costly assessment and investigation without necessarily achieving resolution of their symptoms.
  
  
  METHODS
  In 2011, an integrated team from primary and secondary care developed a business case using baseline data to create a Somerset-wide IBS pathway using Clinical Commissioning Group funding. This provided face-to-face general practitioners (GP) education, developed a diagnostic pathway and funded faecal calprotectin (FC) testing to exclude inflammatory pathology for patients aged 16-45 years with likely IBS and no alarm symptoms. For those with FC≤50 μg/g, we provided a management algorithm and community-based dietetic treatment. Audit results measured usage and outcomes from FC testing, changes in patterns and costs of new patients reviewed in gastroenterology outpatients and dietetic IBS treatment outcomes.
  
  
  RESULTS
  The proportion of new patient slots used reduced from 14.3% to 8.7% over 10 months while overall costs reduced by 25% for patients with no alarm symptoms and likely IBS aged 16-45 years. FC results confirmed research findings with no inflammatory pathology, if FC≤50 μg/g over 2 years. 63% of patients had satisfactory control of their IBS after specialist dietetic input with 74% reporting improved quality of life.
  
  
  CONCLUSIONS
  The combination of GP education, providing diagnosis and management pathways, using FC to exclude inflammatory pathology and providing an effective treatment for patients with likely IBS appeared successful in our pilot. This proved cost-effective, reduced secondary care involvement and improved patient care.
authors.affiliation: Department of Community Dietitian , Somerset Partnership NHS Trust , Bridgwater , UK.
authors.forename: Marianne
authors.initials: M
authors.lastname: Williams
authors.affiliation: Department of Community Dietitian , Somerset Partnership NHS Trust , Bridgwater , UK.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Barclay
authors.affiliation: Somerset Clinical Commissioning Group , Taunton , UK.
authors.forename: Rosie
authors.initials: R
authors.lastname: Benneyworth
authors.affiliation: Yeovil District NHS Foundation Trust , Yeovil , UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Gore
authors.affiliation: Taunton and Somerset NHS Foundation Trust , Taunton, Somerset , UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Hamilton
authors.affiliation: Taunton and Somerset NHS Foundation Trust , Taunton, Somerset , UK.
authors.forename: Rudi
authors.initials: R
authors.lastname: Matull
authors.affiliation: Somerset Clinical Commissioning Group , Wincanton , UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Phillips
authors.affiliation: Department of Community Dietitian , Somerset Partnership NHS Trust , Bridgwater , UK.
authors.forename: Leah
authors.initials: L
authors.lastname: Seamark
authors.affiliation: Somerset Clinical Commissioning Group , Taunton , UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Staveley
authors.affiliation: NHS Somerset , Yeovil , UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Thole
authors.affiliation: Taunton and Somerset NHS Foundation Trust , Taunton, Somerset , UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Greig
keywords: DIET; FUNCTIONAL BOWEL DISORDER; IRRITABLE BOWEL SYNDROME; NUTRITION; QUALITY OF LIFE