The potential of integrated nurse-led models to improve care for people with functional gastrointestinal disorders: A systematic review

Abstract

Functional gastrointestinal disorders (FGID) such as irritable bowel syndrome (IBS) and functional dyspepsia (FD) are extremely common, debilitating and costly. Although diagnostic guidelines and effective management options exist, management is sub-optimal, with long waiting lists, delayed diagnosis and poor patient outcomes. The aim of this systematic review was to explore and evaluate evidence for existing models of care for functional gastrointestinal disorders. 38 studies pertaining to the diagnosis or management of FGIDs were found, however only 6 investigated a full model of care. Five studies assessed a nurse-led model and one a structured gastroenterologist consultation. Nurse-led models were cheaper to current treatments, and resulted in symptomatic improvement, high patient satisfaction, reduced healthcare usage, and improved psychosocial functioning and quality of life, whilst standard gastroenterological care did not improve pain or quality of life. There is minimal research trialling integrated models of care for the diagnosis and management of functional gastrointestinal disorders. This represents a lost opportunity for timely, effective, healthcare provision to a large patient group. Although low in quality, preliminary data suggest that integrated nurse-led models of care are economically viable and may facilitate timely diagnosis and management, and improve patient outcomes. Further, studies to robustly evaluate the efficacy, safety and acceptability of such models are needed.