Implementation of best practice for dyspepsia management in an outpatient hospital setting in Kenya

Abstract

Background: Dyspepsia is a range of symptoms referable to the upper gastrointestinal tract. These include heartburn, acid regurgitation, abdominal bloating, excessive belching, nausea, recurrent vomiting, unexplained weight loss and anaemia. Dyspepsia management is a challenge for clinicians as underlying pathology varies from life threatening to benign. It is vital for patient well-being that individuals with alarm signal symptoms are referred for the kind of treatment their life-threatening symptoms require. To facilitate efficient use of scarce societal resources, which is particularly important in low-resource settings like the one in which this project was undertaken, patients without alarm signals need to be given advice on how to manage their discomfort, not expensive screening tests or treatment. Objectives: The goal of this project was to improve local practice in assessment and management of dyspepsia in an outpatient hospital setting in Kenya. Search strategy: The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in health practice. A baseline audit was conducted followed by an education strategy targeted at clinicians and follow-up audit. Conclusion: The baseline audit revealed large gaps between practice and best practice in all but one of seven audit criteria, namely documentation of acid suppression therapy for patients with alarm symptoms. Resource limitations including lack of equipment (e.g. endoscopy) and insufficient staff to meet demand for services as well as clinicians lacking knowledge about best practice emerged as the primary factors behind the best practice gaps. Poor medical record keeping may explain why the compliance with best practice emerged as so poor for the majority of the audit criteria in the baseline audit. In the follow-up audit, five of the seven audit criteria showed improved compliance with best practice. However, with the exception of one, improvement was off a very low base so there remained much room for improvement. For example, in the second audit, the patient medical records audited showed evidence of only 29% of patients being provided with education about lifestyle modifications that may alleviate dyspepsia symptoms and in only 47% of the patient records is there a note about presence or absence of alarm signals (up from 30% at baseline). Conclusions: The project presents another example of how audit may be used to promote best practice in healthcare. Yet it also shows the vastness of the challenge confronting champions working to promote evidence-informed health practice and equity in access to health services in low-resource settings and the need for not only clinician-focused, capacity-building initiatives but also strategies to mobilise resources for health facilitates. © 2013 The Authors International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.