Download Background to: Research Fellow, Acute Gastroenteritis in Ireland (2

Background to: Research Fellow, Acute Gastroenteritis in Ireland (2 Posts)
Partners: ICGP, QUB, RCGP and FSPB
Introduction
Food-borne diseases are a major global health problem. Worldwide unsafe food has caused
millions of people to become ill of whom many die. In recent years emerging and new
pathogens have been implicated in food scares affecting people in developed and developing
countries. Globally diarrhoeal diseases are one of the five main causes of death in children
under five. In Ireland infectious gastroenteritis and food borne disease is a common problem
in the community. The Acute Gastroenteritis in Ireland North and South Study published in
2003 found that it accounts for 3.2 million new cases each year or 8,800 per day affecting one
in 20 people each month. However this represents the community burden. Infections are also
known to represent a significant workload for GPs and this has not been well documented in
the past.
Background and Rationale
The All Island Collaborative Study on Infectious Gastroenteritis in General Practice found that
it is also a common problem in the primary care setting accounting for almost 1 in every 20
consultations or an average of 7 consultations weekly (approximately 360 annually). This
estimate is similar to the 420 per year estimated by the community-based telephone survey
conducted in 2001. (ref) The study recommended that a physician be appointed to implement
the recommendations of the report in the support of GPs in their management of
gastroenteritis and food borne disease. Many of the major food borne pathogens have
emerged in the past 15-20 years and would not have been included in the undergraduate
curriculum. The specific issues identified for awareness, training and development for this
project are identified below
Aim of Project
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To support the awareness, education and training of general practitioners in the area
of foodborne disease and infectious gastroenteritis.
To enhance the interface between public health and general practice in order to
improve surveillance and monitoring of gastrointestinal infections.
To implement the main recommendations of the All Island Collaborative Study on
Infectious Gastroenteritis in General Practice report.
Specific Objectives
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To develop a primer for physicians aimed at providing concise practical information
on food borne disease to be developed and distributed to GPs in Ireland, North and
South. This needs to be GP specific and practical. The work of Dr Margaret
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O’Riordan and the report produced by the NEHB on hand washing and infection
control will be used as a reference for this work.
To improve treatment practices of general practitioners especially in relation to
antibiotic use. Guidelines on antibiotic prescribing will also be developed.
To provide guidance to GPs and practice nurses on the appropriate use of antidiarrhoeals.
To provide guidance to GPs on exposure history in gastroenteritis / food poisoning
such as being food worker attending a crèche etc. Dr. Andree Rochford’s work on
occupation health in the ICGP may contribute to this aspect.
To support the development of Patient Information leaflets - including
appropriate stool sampling and education of patients about how to take a stool
sample. These will be placed on the ICGP website for downloading and will be
printed as part of an overall information pack if funding is available.
To develop GP awareness of their role in prevention of disease – hygiene, safe food
practices, handwashing, staying away from work. GPs are the best source of patient
information on the management and prevention of acute gastroenteritis. Initiatives
should therefore focus on continued education and training for GPs. GPs can then
pass this information on to patients. Food workers and care workers suffering from
acute gastroenteritis can pose a serious public health risk.
To provide guidance on criteria for stool sampling.
To enhance GP awareness of microbiological and laboratory stool testing through
support and dissemination of lab protocols and to increase GP awareness of routine
testing procedures for making special test requests.
To improve GPs understanding of the notification system and enhance liaison
between public health and general practice. Dr. Michael Joyce, Leader of the
ICGP/NDSC Infectious Disease Surveillance Project will be consulted in respect of
this aspect.
To provide education and awareness on clinical notifications, surveillance and
infectious disease regulations. Notification is a requirement for clinical suspicion of
an infectious disease. In the study most GPs did not routinely notify cases of food
poisoning solely on clinical grounds.
Tasks
I. Education and Training
Focus on trainer and information for trainee modified for CME:
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To develop a postgraduate GP training module on the clinical management of acute
gastroenteritis. The module could be used in both the Vocational Training Scheme (a
three-year rotation for GP training) and Continued Medical Education for trained GPs.
The role for Distance Learning in respect of this will be investigated.
Half day modules for delivery around country to a planned agenda will be developed.
To work with ICGP/RCGP to develop and implement the curriculum/module. To
develop appropriate training material. The CDC’s primer for physicians may serve as
one model for the development of training materials. Best practice and good models
of packs/delivery systems in relation to GPs will be reviewed.
To develop resource material for postgraduate training.
To provide updates on infectious intestinal disease in general practice including
issues relevant to (materials to reflect) patient history, risky behaviours and
exposures.
To provide education to GPs on food safety and food borne disease.
To work with the working group, which is being set up to establish clear guidelines for
use of anti-diarrhoeal agents and antibiotics in the management of acute
gastroenteritis in Ireland, North and South.
II. To enhance sentinel surveillance of infectious gastroenteritis
To expand the number of practices who participate in sentinel surveillance of infectious
diseases and to improve GP awareness and practices in relation to statutory notifications of
infectious diseases.
III. Improve patient care - better detection through stool sampling
Ascertain of pathogen. Support improved practices in stool sampling and microbiological
testing. To develop criteria for stool testing and guidelines for effective and safe.testing.
IV. Improve surveillance & detection of outbreaks
To develop modules for training in prevention of acute gastroenteritis: evidence-based advice
on hygiene, hand washing, safe food preparation.