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Changes in the management of functional constipation by paediatricians after the introduction of nice guidance
  1. M Gordon,
  2. A Akobeng
  1. Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, UK

Abstract

Objectives here has previously been a lack of a nationally agreed evidence based guideline for the management of childhood constipation in the UK, but the National Institute for Clinical Excellence (NICE) released such guidelines in May 2010. When we surveyed general paediatricians in October 2009 they were mostly making treatment decisions based on their own anecdotal experience and perceived a low level of consistency in constipation management among paediatricians. In this survey, we aimed to re-evaluate the consistency of treatment decisions following the introduction of the NICE guidelines.

Methods Between September 2010 and October 2010, an online questionnaire was emailed to all consultant general paediatricians held on an email mailing list in the North West of England. The 11-item questionnaire was developed locally and piloted before its delivery.

Results 25 of 70 consultant paediatricians (36%) in the North West of England replied. The mean length of time of being in a consultant post was 6 years (range, 1 month–20 years). 52% of responders commented on recent changes in their management of constipation, mainly regarding the increased use of Movicol and corresponding reduction in the use of other medications. 88% of responders reported that they used the NICE guidelines to guide their treatment decisions, where as 12 months ago just 48% of respondents reported using any form of guideline to direct treatment decisions. Responders perceived treatment decisions occurring within the region among paediatricians as more consistent than 12 months ago (40% vs 27%). Consultants commented on the clarity and precision of the NICE guidelines, although many felt they had done little to change their practice.

Conclusions This study indicates that since the introduction of the NICE childhood constipation guidelines there has been a major shift in the way paediatricians are guiding their constipation treatment decisions, with almost universal uptake of the guidelines across the North West. Perceived consistency in the management of constipation has also improved.

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