CARE PLAN template material. IBS.
| GP MANAGEMENT PLAN |
| Patient problems / needs / relevant conditions | Goals – changes to be achieved (if possible) | Required treatments and services including patient actions | Arrangements for treatments/services (when, who, and contact details) |
| 1. General | |||
| Irritable Bowel Syndrome | Increase patient’s understanding of condition. | Patient education. Support. | GP |
| Self-management | Develop self-management routine. | Assess patient’s way of self-monitoring: support, educate. Establish and maintain trigger avoidance routine. | GP |
| Dietary management | establish and maintain dietary regimen for best management of IBS | Work together with dietitian in order to establish and maintain dietary regimen for best management of IBS. | GP, Dietitian |
| Psychological management | Manage impact and psychological aspects of IBS | Assess the need of the patient for psychological services. If needed, involve psychologist under GP MHP awareness and discussion of the psycho-social factors that impact upon IBS symptoms awareness and discussion of the role of talking therapies to reduce symptoms of IBS awareness and discussion of the relationship between anxiety / depression and IBS symptoms | GP, psychologist |
| “Red Flags” | Exclude dangerous / underlying conditions | Investigate any “red flags”. Explain all the possibilities to the patient. awareness of the possible differential diagnoses of IBS including inflammatory bowel disease, coeliac disease, and in women ovarian cancer the arrangement of appropriate investigations relevant to the exclusion of serious differential diagnoses | GP |
| Medications | Medications management | a. Assess need for medications. Support and explanation.b. Review medications in order to identify potential triggers of IBS symptoms discussion and awareness of the indications and side effects of drugs relevant to the pharmacological management of IBS which include but are not limited to antispasmodics Mintec Mebeverine digestible fibre therapy Fybogel Pain management therapy tricyclic antidepressants second line agents selective serotonin receptor blockers | GP, Pharmacist |
| 2. Lifestyle | |||
| Healthy lifestyle | Develop and maintain healthy lifestyle routine | Assess lifestyle. Address healthy sleep routine, rest and work balance. | GP |
| Weight | Your target:BMI ≤ 25Men waist ≤ 94 cmWomen waist ≤ 80 cm | MonitorReview 6 monthly | Patient to monitorGP |
| Physical Activity | Your target:At least 30 minutes walking or equivalent 5 or more days per week | Patient exercise routine. Explain importance of exercise in management of IBS. Develop and maintain safe and effective exercise routine | Patient to implementGPPhysiotherapist |
| Smoking | Complete cessation | Smoking cessation strategy:Consider:- Quit- Medication | Patient to manageGP |
| Alcohol | Your target:≤ standard drinks per dayIdeal:≤ 2 standard drinks per day (men)≤ 1 standard drinks per day (women) | Reduce alcohol intakePatient education | Patient to manageGP to monitor |
| 3. Biomedical | |||
| Health check as per current guidelines | Maintain general health | Annual check; BMI, cholesterol, BP, vit D | GP |
Copy of GP Management Plan offered to patient? y
Copy / relevant parts of the GP Management Plan supplied to other providers? y
GP Management Plan added to the patient’s records? y
| Date service was completed: | Proposed Review Date: |
I have explained the steps and any costs involved, and the patient has agreed to proceed with the plan. YES |