DYSPEPSIA MANAGEMENT AND REFERRAL FOR ENDOSCOPY IN FAMILY MEDICINE OUTPATIENTS IN EASTERN PART OF HOSPITAL IN NEPAL

Introduction: The group of conditions collectively termed “Dyspepsia” is the cause of much morbidity and significant mortality in Nepal. In the Family Medicine Outpatient Department around 10% of total cases seen are suffering from dyspepsia. Doctors manag e dyspeptic symptoms but the situation could be improved if doctors agreed to follow a standard protocol such as that proposed by WHO, or the guidelines produced by various national working parties of gastroenterologists and family practitioners.The idea b ehind the proposed study was to implement an internationally accepted guideline for management of dyspepsia in the Family Medicine Outpatient's Department. Objectives: 1. To record the presence of particular clinical features in cases of dyspepsia presenti ng to Family Medicine Outpatients. 2. To measure the effectiveness of the use of an evidence - based clinical algorithm to improve the standard of referrals for endoscopy. 3. To note the outcome of endoscopy in relation to the appropriateness of the referral Materials and Methods: Plan of Action was preformed. Everyday Family Medicine OPD was visited to explain and to collect the survey forms. A one hour educational session was given to the group of doctors working in the Family Medicine OPD. A laminated copy of the algorithm was placed in Family Medicine OPD. The second survey (post - education ) of dyspepsia was started and completed.The researcher visited the outpatients department on a daily basis to collect survey forms and to encourage doctors to use the a lgorithm. Results: There were 38 referrals (38%) to the endoscopist in the pre - education group of 100. After the education session and implementation of the protocol, there were 46 referrals (46%). In the pre - education group, out of 37 referred cases, 77% had positive findings in the pre - education group and 94% in the post - education group. Conclusion: Dyspepsia is a common presentation in the outpatient setting, representing significant morbidity that is usually not serious, but includes some cases that may lead to death through ulcerative complications or because of rare cases of malignancy. The use of a clinical guidelines together with education and reminder visits have been shown to be effective in improving doctor performance in the management of dyspep sia.