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The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies.

Background: The criteria used to identify and diagnose irritable bowel syndrome (IBS) in primary care are unclear, even though most patients are managed entirely in this setting., Objective: To use a validated method of consensus development [Nominal Group Technique (Rand version)] (NGT-R) in order to construct a diagnostic framework for IBS appropriate to primary care., Methods: NGT-R is a formal method of consensus development, which uses structured interaction within a group combined with statistical derivation of group judgements. The group comprised 10 GPs with a special interest in gastroenterology and two gastroenterologists, from 10 European countries. Mailed questionnaires elicited judgements on 242 scenarios for the diagnosis of IBS, within four domains of symptoms, social and lifestyle features, psychological features and investigations. Feedback of group decisions was followed by structured face-to-face interaction and private rescoring of the questionnaire. Consensus was defined as 10/12 ratings within one of three bands, 1-3 (disagreement), 4-6 (equivocal) or 7-9 (agreement)., Results: The defining features of IBS in primary care are alteration in bowel habit, bloating and abdominal pain, or discomfort or annoyance (the last reflecting important cultural differences in symptom description). These symptoms need to be present for at least 4 weeks. Supportive characteristics include female sex, family history of IBS, frequent clinic attendances, a recent major life event and a history of somatization behaviours. Abdominal examination was considered necessary in all patients and rectal examination, haemoglobin estimation and colonoscopy in those aged > 55 years. The subtypes of IBS are recognized, but the diagnostic process differs only in minor ways. Final consensus was reached on 46% of statements., Conclusion: The basis of IBS diagnosis in primary care differs from, and is less exclusive than, existing criteria. Few features are deemed essential for diagnosis, while psychosocial features, patient characteristics and contextual factors are important in increasing diagnostic probability. There are important cultural differences in the description of key symptoms. These results provide information on the defining characteristics of IBS and the diagnostic process, as it occurs in primary care, and can guide clinical practice.

A cross-sectional diagnostic prevalence study was carried out within a multi-centre experiment with open access gastroscopy in Utrecht, The Netherlands. The objective of the study was to contribute to improvement of patient selection for open access gastroscopy and to evaluate diagnostic determinants for peptic ulcer. Data were analysed in all 861 patients who were consecutively newly referred during the experiment to undergo gastrocopy. Patient characteristics and outcomes of gastroscopies were recorded. Univariate and multivariate (logistic) analyses were carried out and the results were evaluated with ROC (receiver operating characteristic) analysis. The most important clinical characteristics to be used for prediction of peptic ulcer are pain on an empty stomach, absence of pain after a meal and absence of obstructive complaints. The scoring list derived from the full model, comprising these characteristics together with age, sex, information on former dyspeptic diseases, medication and smoking ('basic characteristics'), predicted peptic ulcer with an AUC of 0.78. The 'ulcer-like' model, with characteristics known from the literature, had an AUC of 0.76. The amount of gastroscopy requests on patients suspected of a peptic ulcer could have been reduced from 60 to 44%. Forcing 'basic characteristics' into scoring lists on peptic ulcer improved the pre-diagnostic test capacities. The presented scoring list may improve gastroscopy requesting by GPs aiming at finding peptic ulcers. Practical manageability of the list should be prospectively evaluated in future experiments.