Development and validation of a clinical decision-making aid for screening bowel symptoms in community pharmacies.

RATIONALE, AIMS AND OBJECTIVES Bowel symptoms are common, and community pharmacies are an ideal setting for health advice about these symptoms. The aim of this study was to develop and validate a questionnaire for use with adults presenting to community pharmacies with lower bowel symptoms. The purpose of the questionnaire was to stratify people into those requiring medical follow-up for symptoms and those with self-limiting symptoms. METHOD A self-administered questionnaire, named the Jodi Lee test (JLT), was developed in three stages - review of the literature, questionnaire design and statistical validation - against a validated screening tool, the patient consultation questionnaire (PCQ), to assess the sensitivity and specificity of JLT. The questionnaire was developed to be simple, easy for all pharmacy staff to use and require no score calculation. Its application was designed to facilitate referral from pharmacy assistants to pharmacists and from pharmacists to medical practitioners. RESULTS The questionnaire comprises eight questions. It has a Flesh-Kincaid reading score of 79.5. By considering different score thresholds on the PCQ, a receiver operator characteristic (ROC) curve was calculated to assess the effectiveness of the JLT. From a sample of 118 subjects, the area under the ROC curve was 0.94. At a threshold score of 30 on the PCQ, the sensitivity was 100%. The specificity was 65%. CONCLUSION The JLT has high sensitivity for identifying patients with symptoms of serious bowel disease. It is also likely to identify patients who have symptoms of relatively benign disease who would benefit from medical advice.

[1]  Nicholas McInnes,et al.  Readability of online health information: implications for health literacy , 2011, Informatics for health & social care.

[2]  L. Irwig,et al.  The value of age and medical history for predicting colorectal cancer and adenomas in people referred for colonoscopy , 2011, BMC gastroenterology.

[3]  W. Pugh,et al.  How sharp can a screening tool be? A qualitative study of patients’ experience of completing a bowel cancer screening questionnaire , 2011, Health expectations : an international journal of public participation in health care and health policy.

[4]  Rajeev Kumar,et al.  Receiver operating characteristic (ROC) curve for medical researchers , 2011, Indian pediatrics.

[5]  Richard D Neal,et al.  The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. , 2011, The British journal of general practice : the journal of the Royal College of General Practitioners.

[6]  S. Selvachandran,et al.  Use of a patient consultation questionnaire and weighted numerical scoring system for the prediction of colorectal cancer and other colorectal pathology in symptomatic patients: A prospective cohort validation study of a Welsh population , 2010, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[7]  J. Duke,et al.  Do Pharmacists Know Which Patients with Bowel Symptoms Should Seek Further Medical Advice? A Survey of Pharmacists Practicing in Community Pharmacy in Western Australia , 2010, The Annals of pharmacotherapy.

[8]  C. Stålsby Lundborg,et al.  Health promotion at Swedish pharmacies – views of the staff , 2008, Pharmacy practice.

[9]  David B. Jones,et al.  A self administered reliable questionnaire to assess lower bowel symptoms , 2008, BMC gastroenterology.

[10]  W. Steward,et al.  Assessment of a patient consultation questionnaire‐based scoring system for stratification of outpatient risk of colorectal cancer , 2008, The British journal of surgery.

[11]  M. Bulsara,et al.  Referring patients to specialists: A structured vignette survey of Australian and British GPs , 2008, BMC family practice.

[12]  R. Hooker,et al.  Rheumatology Physician Assistant Role Delineation Study.: 10. , 2007 .

[13]  Lauren Kolfenbach.  The pathophysiology, diagnosis, and treatment of IBS , 2007, JAAPA : official journal of the American Academy of Physician Assistants.

[14]  S. Selvachandran,et al.  Symptomatic presentation of early colorectal cancer. , 2006, Annals of the Royal College of Surgeons of England.

[15]  B. Löwe,et al.  Diagnosing ICD-10 Depressive Episodes: Superior Criterion Validity of the Patient Health Questionnaire , 2004, Psychotherapy and Psychosomatics.

[16]  S. Selvachandran,et al.  Prediction of colorectal cancer by a patient consultation questionnaire and scoring system: a prospective study , 2002, The Lancet.

[17]  L. Goldfrank,et al.  The ecology of medical care revisited. , 2001, The New England journal of medicine.

[18]  J. Kanis,et al.  Development of a questionnaire (OPQ) to assess patient's knowledge about osteoporosis. , 2000, Maturitas.

[19]  J. French,et al.  Comparison of gastrointestinal symptoms in colorectal carcinoma patients and community controls with respect to age. , 1994, Gut.

[20]  L. D. O'Donnell,et al.  Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. , 1992, Gastroenterology.

[21]  M. Crawford.  The Art of Readable Writing , 1969 .

[22]  J. Hippisley-Cox,et al.  Identifying patients with suspected colorectal cancer in primary care: derivation and validation of an algorithm. , 2012, The British journal of general practice : the journal of the Royal College of General Practitioners.

[23]  W. C. S. Ping-Delfos,et al.  Could community pharmacies offer an opportunity to improve outcomes for patients with bowel cancer? , 2011, Quality in primary care.

[24]  J. Hippisley-Cox,et al.  Identifying patients with suspected lung cancer in primary care: derivation and validation of an algorithm. , 2011, The British journal of general practice : the journal of the Royal College of General Practitioners.

[25]  Georg Heinze,et al.  Medical Biostatistics I , 2010 .

[26]  M. O’Connor,et al.  Triaging consumers who present bowel symptoms to community pharmacies: a pilot study of two interventions , 2009 .