The daily practice of (suspected) coeliac disease management by general practitioners: A qualitative approach

Background: General practitioners (GPs) play a crucial role in diagnosing coeliac disease (CD). However, data on GP management of (suspected) CD patients is sparse. Objectives: To provide insights into the daily practice of diagnosis, treatment, and follow-up of CD by GPs. Methods: A qualitative study using topic list-based semi-structured in-depth interviews with Dutch GPs with more than five years’ experience carried out between January and March 2017. GPs were purposively sampled. The number of GPs interviewed depended on when data saturation was reached. We applied content analysis to the semi-structured interviews. Results: Seven GPs were interviewed, five of whom were female. Analysis of the interviews resulted in three main themes: ‘awareness,’ ‘diagnostics’ and ‘management.’ Vague gastrointestinal symptoms and diarrhoea were often mentioned as a possible presentation of CD. Antibodies were used in CD diagnosis, although some GPs would start a gluten-free diet as a first diagnostic tool. Some GPs diagnosed CD only based on positive antibodies without referring to secondary care or duodenal biopsy analysis. GPs mentioned no role for primary care physicians in the follow-up of CD and noted the important role of dieticians in CD management. Conclusion: The different views of GPs on how to diagnose and monitor CD could be a basis for further research to improve CD detection rate and CD care.