Production and evaluation of guidelines for the management of inflammatorybowel disease: the Leicester experience

Consensus guidelines for the management of patients with inflammatory bowel disease were produced by gastroenterologists, gastrointestinal surgeons an d a cross-section of general practitioners (GPs) from Leicestershire in ord er to develop a seamless pattern of care with a common approach to diagnosi s and treatment. It was hoped that the guidelines would encourage a movemen t towards care in the community for many patients with stable disease and s o speed up new consultation rates. The study then assessed the impact of th ese guidelines on the referral letters of GPs to hospital consultants, the prediction of disease and adherence to them on re-referring patients after discharge. The guidelines were distributed to all 487 GPs in the Leicester Health Authority area and the gastroenterology teams within the hospitals. The value of the guidelines was assessed by an audit of referral letters, t he length of time from referral letter to out-patient appointment, both bef ore and after the launch of the guidelines, adherence to the guidelines on re-referral, and monitoring the outcome of the discharged patients. Whilst the guidelines may have helped GPs to manage stable patients in the communi ty, the content of referral letters and the diagnostic abilities of GPs wer e not seen to improve since the launch of the guidelines. However, only 5% of stable patients who were discharged from one clinic were re-referred for inflammatory bowel disease.