Knowledge, skills, and barriers to management of faecal incontinence in Australian primary care: a cross-sectional study

Abstract

Background: GPs play an important role in the diagnosis and management of patients with faecal incontinence (FI). However, their confidence and ability in this role are unknown. Aim: This study aimed to investigate the knowledge, skills, and confidence of GPs to manage FI in primary care, and identify barriers to optimal management. Design & setting: A cross-sectional study using self-administered questionnaires of GPs attending health education seminars, which took place across Australian capital cities. Method: Main outcome measures included: (i) clinical exposure to and previous training in FI; (ii) knowledge and skills in screening, diagnosing, and managing FI; and (iii) barriers and facilitators to optimising care. Associations between demographics, training and knowledge and skills were assessed. Results: Some 1285 of 1469 GPs (87.5%) participated (mean 47.7 years [standard deviation {SD} 11.3]). The vast majority reported poor clinical exposure to (88.5%) and training in FI management (91.3%). Subjectively, 69.7% rated their knowledge and skills in screening, assessing, and treating FI as suboptimal. The most commonly reported barrier to FI care was ‘insufficient skills’ (56.1%); facilitators were improved referral pathways (84.6%) and increased training (67.9%). GPs with more training had better knowledge (odds ratio [OR] = 24.62, 95% confidence interval [CI] = 13.32 to 45.51) and skills (OR = 13.87, 95% CI = 7.94 to 24.24) in managing FI. Conclusion: Clinical exposure to and training in FI among GPs was poor. Accordingly, knowledge, skills, and confidence to manage FI was suboptimal. GPs recognise the importance of FI and that increased training and/or education and formalisation of referral pathways may improve the care of patients with FI in primary care.