Should diverticulitis be managed in primary care? An audit on the management of diverticulitis in primary care.

Abstract

BACKGROUND: The prevalence of diverticulosis and acute diverticulitis is increasing in developed countries. For those with diverticulosis the lifetime risk of developing acute diverticulitis is about 4-25%. Mild, uncomplicated diverticulitis can be, and often is, managed safely in a primary care setting, avoiding unnecessary admission. AIM: To evaluate management of suspected diverticulitis in primary care against standards set by the National Institute for Health and Care Excellence (NICE) and review admission rates following primary care management. METHOD: An electronic search on EMIS Web using Read codes 'diverticulitis', 'diverticulosis', and 'diverticular disease', with a specified period of 2017-2019. All consultations with suggestions of an infective flare of diverticular disease were included in the study. Clinical data from the consultations were extracted and retrospectively audited. RESULTS: A total of 64 patients were identified with diverticular disease or diverticulosis. Of those, 42% (n = 27) presented to primary care with presenting complaints suspicious of diverticulitis. A total of 64 consultations were reviewed, as several patients presented more than once in the study period. Of the consultations reviewed, 12.5% (n = 8) resulted in referral to the surgical assessment unit. Antibiotics were prescribed after 68.4% (n = 39) of consultations. Bloods for inflammatory markers were performed after 19.3% (n = 11) of consultations. Only 3.5% (n = 2) of patients were reviewed within the recommended 48-hour timeframe. Only 3.5% (n = 2) of patients subsequently deteriorated and required admission. CONCLUSION: The management of diverticulitis in this primary care centre is not fully concordant with NICE guidelines. There is a need to improve adherence, in particular antibiotic regimen when deciding to prescribe antibiotics.