PMID- 15844697
OWN - NLM
STAT- MEDLINE
DCOM- 20050511
LR  - 20190721
IS  - 0163-2116 (Print)
IS  - 0163-2116 (Linking)
VI  - 50
IP  - 4
DP  - 2005 Apr
TI  - Attitudes and referral patterns of primary care physicians when evaluating 
      subjects with noncardiac chest pain--a national survey.
PG  - 656-61
AB  - Noncardiac chest pain (NCCP) may affect up to 23% of the U.S. population. The 
      clinical approach and referral patterns of primary care physicians (PCPs) when 
      evaluating NCCP subjects are unknown. We aimed to determine the preferences of 
      diagnostic tests, referral patterns, and treatment plans of NCCP patients by 
      PCPs. PCPs were randomly selected from the American Medical Association national 
      membership list. A 24-item questionnaire was mailed, which focused on demographic 
      information, characteristics of practice, preferences of diagnostic tests, 
      referral patterns, and treatment plans. Two hundred five (40%) PCPs returned the 
      questionnaire (mean age, 49; 77% males; practice type--community-based, 40.5%; 
      hospital-based, 10.7%; and combined, 47.3%; physician type--internists, 46.3%; 
      family physicians, 44.4%; general practitioners, 4.9%; and others, 2.9%). The 
      mean number of NCCP patients seen in the past 6 months was 108 (6.4% of total 
      patients) and 79.5% were treated primarily by PCPs. The three most common 
      diagnostic tests used were empirical proton pump inhibitor (PPI) trial (45.6%), 
      chest radiograph (39.9%), and upper endoscopy (18.7%). Most PCPs reported that 
      they are either comfortable (44.6%) or very comfortable (21.2%) in diagnosing 
      NCCP. The three most commonly used therapeutic modalities for NCCP were PPIs 
      (37.8%), lifestyle modification (33.7%), and H2 blockers (12.4%). Of those NCCP 
      patients referred to a subspecialist, most ended up in gastroenterology (75.6%), 
      followed by cardiology (7.8%) and pulmonary (1.6%) clinics. We conclude that most 
      PCP's diagnose and treat NCCP patients without referring them to a 
      gastroenterologist. However, diagnostic and treatment strategies may not follow 
      the current understanding and knowledge of the disorder.
FAU - Wong, Wai-Man
AU  - Wong WM
AD  - The Neuro-Enteric Clinical Research Group, Section of Gastroenterology, 
      Department of Medicine, Southern Arizona VA Health Care System, Tucson, Arizona 
      85723, USA.
FAU - Beeler, Joy
AU  - Beeler J
FAU - Risner-Adler, Sara
AU  - Risner-Adler S
FAU - Habib, Sara
AU  - Habib S
FAU - Bautista, Jimmy
AU  - Bautista J
FAU - Fass, Ronnie
AU  - Fass R
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - *Attitude of Health Personnel
MH  - Chest Pain/*diagnosis/drug therapy/therapy
MH  - Endoscopy
MH  - Female
MH  - Histamine H2 Antagonists/therapeutic use
MH  - Humans
MH  - Life Style
MH  - Male
MH  - Middle Aged
MH  - Physicians, Family/*psychology
MH  - Proton Pump Inhibitors
MH  - Radiography, Thoracic
MH  - *Referral and Consultation/statistics & numerical data
MH  - Surveys and Questionnaires
EDAT- 2005/04/23 09:00
MHDA- 2005/05/12 09:00
CRDT- 2005/04/23 09:00
PHST- 2005/04/23 09:00 [pubmed]
PHST- 2005/05/12 09:00 [medline]
PHST- 2005/04/23 09:00 [entrez]
AID - 10.1007/s10620-005-2552-6 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2005 Apr;50(4):656-61. doi: 10.1007/s10620-005-2552-6.