Acute gastroenteritis in primary care: a longitudinal study in the Swiss Sentinel Surveillance Network, Sentinella

Abstract

Purpose: Acute gastroenteritis (AG) leads to considerable burden of disease, health care costs and socio-economic impact worldwide. We assessed the frequency of medical consultations and work absenteeism due to AG at primary care level, and physicians' case management using the Swiss Sentinel Surveillance Network "Sentinella".

Methods: During the 1-year, longitudinal study in 2014, 172 physicians participating in "Sentinella" reported consultations due to AG including information on clinical presentation, stool diagnostics, treatment, and work absenteeism.

Results: An incidence of 2146 first consultations due to AG at primary care level per 100,000 inhabitants in Switzerland was calculated for 2014 based on reported 3.9 thousand cases. Physicians classified patients' general condition at first consultation with a median score of 7 (1 = poor, 10 = good). The majority (92%) of patients received dietary recommendations and/or medical prescriptions; antibiotics were prescribed in 8.5%. Stool testing was initiated in 12.3% of cases; more frequently in patients reporting recent travel. Among employees (15-64 years), 86.3% were on sick leave. Median duration of sick leave was 4 days.

Conclusions: The burden of AG in primary care is high and comparable with that of influenza-like illness (ILI) in Switzerland. Work absenteeism is substantial, leading to considerable socio-economic impact. Mandatory infectious disease surveillance underestimates the burden of AG considering that stool testing is not conducted routinely. While a national strategy to reduce the burden of ILI exists, similar comprehensive prevention efforts should be considered for AG.

Keywords: Acute gastroenteritis; Antibiotics; Infectious intestinal diseases; Primary health care; Sentinel surveillance; Switzerland.

Fig. 1

Study profile of notified cases and reporting physicians. Acute gastroenteritis study, Swiss Sentinel Surveillance Network, 2014. AG acute gastroenteritis, PPC physician–patient contact

Fig. 2

Age distribution by sex among acute gastroenteritis cases reported by Sentinella-physicians on weekly and/or supplementary questionnaires. Swiss Sentinel Surveillance Network, 2014; age distribution of Swiss population (official numbers [17]) added for comparison

Fig. 3

Acute gastroenteritis cases reported by physicians from the Swiss Sentinel Surveillance Network in 2014 (28.12.2013–26.12.2014): weekly case numbers (bars) and number of initial AG consultations per 1000 physician–patient contacts (PPCs, “consultations”) per week (line). Vertical, dashed line date of change of sampling scheme (from subsample of cases with supplementary questionnaires to supplementary questionnaire for every reported case)

Fig. 4

Calculated incidence of first consultations due to acute gastroenteritis at primary care level in Switzerland by Sentinella-region, based on standard extrapolation. Swiss Sentinel Surveillance Network, 2014. Note: an outlier (one physician reporting 400 cases) was excluded from this extrapolation by region. Source of map shapefile: Swiss Federal Office of Topography