Future challenges and directions in functional gastrointestinal disorders – integrated and biopsychosocial care approaches
This chapter reviews the current evidence for holistic care for functional gastrointestinal disorders (FGIDs) and suggests avenues for future gains. It includes the need for an integrated health-care approach, current recommendations for integrated care, benefits of integrated approaches, gaps between recommendations and practice and the evidence for models of integrated care. McKinsey research has identified four elements which are critical to successful integrated care: patient education and empowerment, care coordination, multidisciplinary teams and individual care plans. Only one small study in New Zealand trialled an integrated model of care in a secondary care setting in the form of a private nurse-led IBS clinic. Early results from a small Australian trial suggest the usefulness of an algorithm-based approach to the diagnosis and management of FGIDs which does not depend on specialist consultation. Most models reviewed centre around an ongoing supportive relationship with a nurse who co-ordinates and reviews care.