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Tianeze de Castro C, da Silva Oliveira D, Freire de Melo F, Lima Barreto M, de Souza Teles Santos CA, Barbosa Dos Santos D. Global prevalence of biologic drugs use in inflammatory bowel diseases: a systematic review and meta-analysis. Scand J Gastroenterol 2025; 60:439-453. [PMID: 40237230 DOI: 10.1080/00365521.2025.2491013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 02/17/2025] [Accepted: 04/04/2025] [Indexed: 04/18/2025]
Abstract
OBJECTIVES Biologics are increasingly essential in managing inflammatory bowel diseases (IBDs) worldwide, as they can modify disease progression and improve patients' quality of life. This study aimed to analyze the global prevalence of and geographic variations in the use of biological drugs for IBD. MATERIALS AND METHODS Articles published up to 21 July 2024, were identified from the PubMed/MEDLINE, Web of Science, Scopus, Embase, IBECS, WPRIM, BRISA/RedETSA and LILACS databases. Population-based studies (cohort, case-control and cross-sectional) and studies using administrative databases with data on the prevalence of biological medicine use in patients with IBD were included. Two reviewers independently screened the studies, extracted data, and assessed methodological quality. Estimates were pooled using a random-effects meta-analysis, whereas heterogeneity was evaluated using Cochran's Q test and I2. RESULTS Of the 8239 titles, 68 (n = 3,482,385 patients) were included. An increase in the number of studies on the subject has been reported since 2017, and these studies have been mostly concentrated in high-income countries. A 15.06% (95% CI 11.84-18.28%) prevalence of biologic use in IBD worldwide was reported, predominantly concentrated in the use of anti-TNF agents 15.01% (95% CI 10.35-19.67%). Furthermore, patients with Crohn's disease (CD) had a greater prevalence of biologic use (21.41%; 95% CI 16.31-26.50%) than ulcerative colitis (UC) patients (9.70%; 95% CI 6.20-13.18%). CONCLUSIONS Further studies using population-based and administrative data and stratifying their analyses by disease type are required to confirm our findings. Future studies should be conducted in Latin America, Asia and Africa.
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Affiliation(s)
| | | | | | - Mauricio Lima Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Carlos Antonio de Souza Teles Santos
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
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Edwards Q, Ayo-Farai O, Uwumiro FE, Komolafe B, Chibuzor OE, Agu I, Nwuke HO, Uwaoma GC, Amadi ES, Enyi M, Idahor C, Omeh CK. Decade-Long Trends in Hospitalization, Outcomes, and Emergency Department Visits for Inflammatory Bowel Diseases in the United States, 2010 to 2020. Cureus 2025; 17:e77941. [PMID: 39996174 PMCID: PMC11847953 DOI: 10.7759/cureus.77941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2025] [Indexed: 02/26/2025] Open
Abstract
Background Data on trends in inflammatory bowel disease (IBD) hospitalizations in the literature are sparse and conflicting. This study evaluated trends in hospitalization and emergency department (ED) visits for IBD between 2010 and 2020 using large data from the United States national inpatient and emergency department sample databases. Methods We employed joinpoint regression analysis and Cuzick's tests to examine trends in hospitalizations, emergency department (ED) visits, and outcomes of hospitalization for IBD using nationwide inpatient and ED sample databases. Hospitalization costs were adjusted for inflation using the medical expenditure panel survey index. Results We analyzed 2,504,288 Crohn's Disease (CD) and 1,367,809 ulcerative colitis (UC) hospitalizations. There was an uptrend in the mean age of patients with IBD from 52.3 years in 2010 to 55.8 years in 2020 (P <0.001). Hospitalizations for IBD showed an upward trend with an average annual percent change (APC) of 0.92% (confidence interval [CI]: 0.67-1.17; P<0.001) and a marked increase in CD hospitalization until 2014 (APC, 2.16%; CI, 1.35-4.64; P=0.040). After 2014, CD hospitalizations showed a downward trend to 219,200 with an AAPC of -0.1% (CI: -1.79 to 1.61; P=0.890), whereas UC hospitalizations steadily increased over the decade (120,346 to 122,485; APC, 0.63%; CI, 0.52-0.74; P<0.001). Mortality rates increased by an average APC of 3.16% (P=0.002), especially among the middle-aged and older adults. Aggregate annual IBD hospitalization costs were $9.1 billion higher in 2020 than in 2010 (APC: 3.97% (CI: 2.98-4.97; P<0.001). There were 6,243,807 ED visits for IBDs over the study period. There was no significant change in the overall number of ED visits for IBD over the study period (574,038 to 448,647; APC: 0.1%; CI: -0.42 to 0.54; P=0.792). There was an uptrend in the total number of in-hospital procedures for IBD (622,647 to 642,210; APC: 0.64%; CI: 0.35-0.93; P=0.001). There was an uptrend in the incidence of combined incidences of malnutrition, anemia, bowel perforations, fistulae, and critical care admission for IBD (P trend for all < 0.001). Conclusion IBD hospitalization rates have increased with aging patient demographics, rising mortality rates, and increased healthcare spending over the past decade.
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Affiliation(s)
- Queeneth Edwards
- Internal Medicine, Georgia Southern University, Statesboro, Georgia, USA
| | - Oluwatoyin Ayo-Farai
- Epidemiology and Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA
| | | | - Babajide Komolafe
- Internal Medicine, College of Medicine, University of Lagos, Lagos, NGA
| | | | - Ifeanyi Agu
- Internal Medicine, Imo State University College of Medicine, Owerri, NGA
| | | | - Gentle C Uwaoma
- Internal Medicine, College of Medicine, University of Nigeria, Enugu, NGA
| | - Emmanuel S Amadi
- Internal Medicine, Hallel Hospital Port Harcourt, Port Harcourt, NGA
| | - Marvis Enyi
- Internal Medicine, Imo State University Teaching Hospital, Owerri, NGA
| | - Courage Idahor
- Emergency Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Chinyere K Omeh
- Internal Medicine, 161 Nigerian Airforce Hospital, Makurdi, NGA
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Simard AA, Kotamraju S, DeFazio JR, Picoraro JA. Role of ileal diversion in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2024; 79:800-806. [PMID: 39075806 DOI: 10.1002/jpn3.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/04/2024] [Accepted: 07/02/2024] [Indexed: 07/31/2024]
Abstract
Surgical intervention is often indicated in pediatric inflammatory bowel disease (IBD) for medically refractory disease or complications of severe disease. Specifically, surgical intervention via ileal diversion allows for fecal flow to be redirected away from diseased distal bowel and through an ileostomy. It is utilized in patients who have medically refractory colitis, severe perianal disease, or irreversible bowel damage. In patients with ulcerative colitis, it is primarily performed during a restorative proctocolectomy with ileal pouch anal anastomosis to protect the high-risk anastomoses. In the setting of Crohn's disease, ileal diversion reduces the exposure of diseased distal intestine to pro-inflammatory stool. During perioperative planning, it is crucial for the gastroenterologist to partner early with a multidisciplinary team including surgeons, nutritionists, wound ostomy care nurses, psychologists, and social workers. Patients should be assessed for malnutrition and should be optimized nutritionally with enteral or parenteral nutrition. As they are associated with increased risk of postoperative complications, corticosteroids should be significantly reduced or completely discontinued preoperatively. Though ileal diversion may reduce the complications associated with anastomosis, serious postoperative complications can include diversion colitis and high-output fistulae. This review aims to provide an overview of the role of ileal diversion in the treatment of pediatric IBD to pediatric gastroenterologists to inform their medical decision-making and discussions with patients and families.
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Affiliation(s)
- Amanda A Simard
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Swetha Kotamraju
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center, New York, New York, USA
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Jennifer R DeFazio
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
- Division of Pediatric Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Joseph A Picoraro
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center, New York, New York, USA
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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Rohatinsky N, Tooke N, Fowler S, Rueda-Clausen C, Morrison D, Winchester J, Peña-Sánchez JN. Identification and prioritization of patient-centred strategies to enhance IBD-related care for older adults: a modified Delphi approach. J Can Assoc Gastroenterol 2024; 7:384-392. [PMID: 39416722 PMCID: PMC11477976 DOI: 10.1093/jcag/gwae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2024] Open
Abstract
Background The older adult age group makes up one of the fastest-growing groups of individuals with inflammatory bowel disease (IBD). It is important to hear the perspectives of older adults living with IBD about care experiences and managing their illness. The purpose of this patient-oriented study was to identify and prioritize patient-centred strategies that have the potential to enhance IBD-related care for older adults in Saskatchewan. Methods The interprofessional research team, consisting of older adult individuals living with IBD, gastroenterology providers, and researchers specializing in IBD or older adult education used a modified Delphi approach to identify and prioritize strategies that may enhance IBD-related care for older adults. Thirty-one older adults with IBD participated in ranking, revising, and prioritizing statements related to their chronic illness care. Nine statements were developed that highlighted strategies for older adult IBD care. Results Through the consensus process, 6 statements were retained. Co-creating a treatment plan with the IBD provider was ranked as the top priority statement for older adults with IBD. Conclusion Facilitating collaborative relationships and understanding individual priorities for IBD-related care for older adults has the potential to enhance positive health outcomes and quality of life for these individuals.
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Affiliation(s)
- Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, 4342-104 Clinic Place, Saskatoon, Saskatchewan, S7N 2E5, Canada
| | - Natasha Tooke
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Sharyle Fowler
- College of Medicine, Gastroenterology and Hepatology, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Christian Rueda-Clausen
- Department of Gastroenterology and Hepatology, College of Medicine, University of Saskatchewan, Regina, Saskatchewan, S4P 0W5, Canada
| | - Dirk Morrison
- Department of Curriculum Studies, College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0X1, Canada
| | | | - Juan-Nicolás Peña-Sánchez
- College of Medicine, Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada
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Rohatinsky N, Chauhan U, Currie B, Peacock S, Phalen-Kelly K, Russell B, Tooke N. Older Adults With Inflammatory Bowel Disease in Canada: A Mixed-Methods Exploratory Study of Care Experiences and Health-Related Quality of Life. Gastroenterol Nurs 2024; 47:41-51. [PMID: 37556367 PMCID: PMC10833196 DOI: 10.1097/sga.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/23/2023] [Indexed: 08/11/2023] Open
Abstract
Literature exploring the health-related quality of life and care experiences of older adults with inflammatory bowel disease is limited despite the increasing prevalence in this population. The purpose of this study was to explore the perceived health-related quality of life and care experiences in older adults with inflammatory bowel disease in Canada. This study used a mixed-methods convergent design consisting of a descriptive, cross-sectional survey and qualitative descriptive interviews. Fifty-eight participants completed the survey and 24 participants completed interviews. Older adults reported satisfaction with inflammatory bowel disease-related care, high levels of disease control, moderate health-related quality of life, and low levels of patient-healthcare team interactions. Themes identified were (1) Experiences of inflammatory bowel disease in daily life; (2) Accessibility of inflammatory bowel disease-related health services; and (3) Communication and relationships to facilitate inflammatory bowel disease care. Ultimately, quality inflammatory bowel disease care for older adults is contingent upon communication between patients and providers, access to multidisciplinary clinics, and support networks. By ensuring these factors are present, providers and patients can work together collectively toward positive patient outcomes, enhanced satisfaction with care, and greater perceived quality of care.
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Affiliation(s)
- Noelle Rohatinsky
- Correspondence to: Noelle Rohatinsky, PhD, RN, College of Nursing, University of Saskatchewan, 4342 Health Sciences Building, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada ()
| | - Usha Chauhan
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Barbara Currie
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shelley Peacock
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kelly Phalen-Kelly
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brooke Russell
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Natasha Tooke
- Noelle Rohatinsky, PhD, RN, is Associate Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Usha Chauhan, MN, NP, is Nurse Practitioner at the Hospital Hamilton Health Sciences, Hamilton, Ontario, Canada
- Barbara Currie, MN, RN-NP, is Nurse Practitioner at the Nova Scotia Collaborative IBD Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Shelley Peacock, PhD, RN, is Professor at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kelly Phalen-Kelly, MHSc, NP, is Nurse Practitioner at the Nova Scotia Health, Halifax, Nova Scotia, Canada
- Brooke Russell, BSN, RN, is Research Assistant at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Natasha Tooke, MN, RN, is Research Trainee at the College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kumar A, Yassin N, Marley A, Bellato V, Foppa C, Pellino G, Myrelid P, Millan M, Gros B, Avellaneda N, Catalan-Serra I, El-Hussuna A, Cunha Neves JA, Roseira J, Cunha MF, Verstockt B, Bettenworth D, Mege D, Brookes MJ. Crossing barriers: the burden of inflammatory bowel disease across Western Europe. Therap Adv Gastroenterol 2023; 16:17562848231218615. [PMID: 38144422 PMCID: PMC10748558 DOI: 10.1177/17562848231218615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/16/2023] [Indexed: 12/26/2023] Open
Abstract
An estimated 2.5-3 million individuals (0.4%) in Europe are affected by inflammatory bowel disease (IBD). Whilst incidence rates for IBD are stabilising across Europe, the prevalence is rising and subsequently resulting in a significant cost to the healthcare system of an estimated 4.6-5.6 billion euros per year. Hospitalisation and surgical resection rates are generally on a downward trend, which is contrary to the rising cost of novel medication. This signifies a large part of healthcare cost and burden. Despite publicly funded healthcare systems in most European countries, there is still wide variation in how patients receive and/or pay for biologic medication. This review will provide an overview and discuss the different healthcare systems within Western Europe and the barriers that affect overall management of a changing IBD landscape, including differences to hospitalisation and surgical rates, access to medication and clinical trial participation and recruitment. This review will also discuss the importance of standardising IBD management to attain high-quality care for all patients with IBD.
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Affiliation(s)
- Aditi Kumar
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, UK B15 2GW
| | - Nuha Yassin
- Department of Colorectal Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Alexandra Marley
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Vittoria Bellato
- Department of Minimally Invasive Surgery, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Caterina Foppa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianluca Pellino
- Colorectal Surgery, Vall D’Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Universita degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Monica Millan
- Department of Surgery, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - Beatriz Gros
- Department of Gastroenterology and Hepatology, Reina Sofia University Hospital, Cordoba, Spain
- Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Nicolas Avellaneda
- General and Colorectal Surgery Department, CEMIC University Hospital, Buenos Aires, Argentina
| | - Ignacio Catalan-Serra
- Department of Gastroenterology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - João A. Cunha Neves
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Joana Roseira
- Department of Gastroenterology, Algarve University Hospital Centre, Portimão, Portugal
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
| | - Miguel F. Cunha
- Algarve Biomedical Centre, University of Algarve, Faro, Portugal
- Department of Colorectal Surgery, Algarve University Hospital Centre, Portimão, Portugal
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dominik Bettenworth
- CED Schwerpunktpraxis, Münster, Germany
- Medical Faculty, University of Münster, Münster, Germany
| | - Diane Mege
- Department of Digestive and Oncology Surgery, Timone University Hospital, Marseille, France
| | - Matthew J. Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- School of Medicine and Clinical Practice, Faculty of Sciences and Engineering, University of Wolverhampton, Wolverhampton UK
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7
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Mathias H, Rohatinsky N, Murthy SK, Novak K, Kuenzig ME, Nguyen GC, Fowler S, Benchimol EI, Coward S, Kaplan GG, Windsor JW, Bernstein CN, Targownik LE, Peña-Sánchez JN, Lee K, Ghandeharian S, Jannati N, Weinstein J, Khan R, Im JHB, Matthews P, Davis T, Goddard Q, Gorospe J, Latos K, Louis M, Balche N, Dobranowski P, Patel A, Porter LJ, Porter RM, Bitton A, Jones JL. The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care. J Can Assoc Gastroenterol 2023; 6:S111-S121. [PMID: 37674496 PMCID: PMC10478809 DOI: 10.1093/jcag/gwad007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56-66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Kerri Novak
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Mount Sinai IBD Centre of Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sharyle Fowler
- Department of Gastroenterology and Hepatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Coward
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kate Latos
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Naji Balche
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Ashley Patel
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | | | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Rohatinsky N, Russell B, Read KB. The Experiences of Older Adults Living With Inflammatory Bowel Disease: A Scoping Review. Gastroenterol Nurs 2023; 46:296-308. [PMID: 37158397 DOI: 10.1097/sga.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 02/23/2023] [Indexed: 05/10/2023] Open
Abstract
The prevalence of inflammatory bowel disease is rising in persons older than 65 years. Although there is extensive literature on inflammatory bowel disease in older adults from a disease-related outcome, epidemiological, and treatment perspective, the older adult perspective on inflammatory bowel disease-related care needs and experiences is not well represented. This scoping review examines the existing literature regarding the care experiences of older adults living with inflammatory bowel disease. A systematic search was conducted using 3 concepts: older adults, inflammatory bowel disease, and patient experience. Seven publications met the inclusion criteria. Reported data include study design and methods, sample characteristics, and findings relevant to the research question. Two themes were identified: preferences for interactions with healthcare personnel and peer support networks, and barriers to accessing care for inflammatory bowel disease needs. An overarching concept across all studies was the need and request for individualized, patient-centered care where patient preferences are considered. This review highlights the need for more research on the older adult age group to guide evidence-informed practice that meets their individual inflammatory bowel disease care needs.
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Affiliation(s)
- Noelle Rohatinsky
- Noelle Rohatinsky, PhD, RN, CMSN(c), is Associate Professor, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Brooke Russell, BSN, RN, is Research Assistant, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kevin B. Read, MLIS, MAS, is Associate Librarian, Health Sciences Library, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brooke Russell
- Noelle Rohatinsky, PhD, RN, CMSN(c), is Associate Professor, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Brooke Russell, BSN, RN, is Research Assistant, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kevin B. Read, MLIS, MAS, is Associate Librarian, Health Sciences Library, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kevin B Read
- Noelle Rohatinsky, PhD, RN, CMSN(c), is Associate Professor, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Brooke Russell, BSN, RN, is Research Assistant, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Kevin B. Read, MLIS, MAS, is Associate Librarian, Health Sciences Library, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Miles M, Peña-Sánchez JN, Heisler C, Cui Y, Mathias H, Stewart M, Jones JL. Models of Care for Inflammatory Bowel Disease: A National Cross-sectional Survey to Characterize the Landscape of Inflammatory Bowel Disease Care in Canada. CROHN'S & COLITIS 360 2022; 4:otac046. [PMID: 36778510 PMCID: PMC9802273 DOI: 10.1093/crocol/otac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background Collaborative care models improve inflammatory bowel disease (IBD) patient outcomes, yet little is known about the capacity or available resources to deliver such model of care in Canada. We aimed to describe the structure and process characteristics of clinical care delivery models for IBD across Canada, including the number of collaborative care centers. Methods A cross-sectional study was conducted between November 2017 and October 2018 through an online survey. This survey was distributed to gastroenterologists at community and academic centers across Canada who provide care for IBD patients. Comparisons between collaborative and non-collaborative centers were analyzed using chi-squares or t-tests. Descriptive statistics of respondent demographics were also generated. Results Seventy-two gastroenterologists from 62 unique IBD centers completed the survey. A total of 7 unique collaborative centers and 55 unique non-collaborative centers were identified. There were significant differences between collaborative and non-collaborative centers in some aspects of access to IBD care, patient assessment and referral process, and patent education and empowerment. Notably, very few centers had processes for implementing and evaluating evidence-based clinical pathways, and auditing quality indicators. Conclusions Our findings identify areas for improving the quality of IBD care in Canada. Expanding the number of and access to collaborative care centers in Canada is needed, in addition to increased focus on patient education, communication, and implementation of evidence-based care pathways.
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Affiliation(s)
- Matthew Miles
- Present address: South Health Campus, Alberta Health Services, Calgary, Alberta, Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Courtney Heisler
- Division of Digestive Care and Endoscopy, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Yunsong Cui
- Atlantic PATH, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Holly Mathias
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Stewart
- Division of Digestive Care and Endoscopy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer L Jones
- Address correspondence to: Jennifer L. Jones, MD, MSc, FRCPC, Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University, Queen Elizabeth II Health Sciences Center, Suite 915 Victoria Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada ()
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Santos JDM, Fowler S, Jennings D, Brass C, Porter L, Porter R, Sanderson R, Peña-Sánchez JN. Health care utilization differences between First Nations people and the general population with inflammatory bowel disease: a retrospective cohort study from Saskatchewan, Canada. CMAJ Open 2022; 10:E964-E970. [PMID: 36319027 PMCID: PMC9633056 DOI: 10.9778/cmajo.20220118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Indigenous people in Canada often face barriers to access specialized care, with limited data in evaluating health care utilization among Indigenous people with inflammatory bowel disease (IBD). We aimed to compare health care utilization between First Nations patients and those in the general population diagnosed with IBD in Saskatchewan. METHODS We conducted a patient-oriented, population-based, retrospective cohort study by linking administrative health databases of Saskatchewan between fiscal years 1998/99 and 2017/18. We designed and completed this study in partnership with Indigenous patients and family advocates. We applied a validated algorithm to identify IBD incident cases and then used the self-declared First Nations status variable to divide those cases. We applied a 1:5 ratio for age and sex matching and used Cox proportional models to assess associations. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. RESULTS We created a matched cohort with 696 IBD incident cases: 116 First Nations patients and 580 patients in the general population. We observed differences between the groups for IBD-specific hospital admissions (HR 1.33, 95% CI 1.01-1.75), IBD-related hospital admissions (HR 1.55, 95% CI 1.20-2.01), medication claims for IBD (HR 0.52, 95% CI 0.41-0.65) and 5-aminosalicylic acid claims (HR 0.56, 95% CI 0.45-0.71) adjusting by rural or urban residence and diagnosis type. There were no significant differences in the hazard rate of outpatient gastroenterology visits (HR 1.13, 95% CI 0.90-1.41), colonoscopies (HR 1.14, 95% CI 0.92-1.41) and surgeries for IBD (HR 1.14, 95% CI 0.80-1.64). INTERPRETATION We identified that First Nations patients diagnosed with IBD had a higher rate of hospital admissions owing to IBD than patients in the general population diagnosed with IBD. We also found an inverse association between First Nations status and having prescription medication claims for IBD.
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Affiliation(s)
- José Diego Marques Santos
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Sharyle Fowler
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Derek Jennings
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Colten Brass
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Linda Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Robert Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Rhonda Sanderson
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Juan Nicolás Peña-Sánchez
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask.
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11
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Peña-Sánchez JN, Osei JA, Marques Santos JD, Jennings D, Andkhoie M, Brass C, Bukassa-Kazadi G, Lu X, Johnson-Jennings M, Porter L, Porter R, Quintin CL, Sanderson R, Teucher U, Fowler S. Increasing Prevalence and Stable Incidence Rates of Inflammatory Bowel Disease Among First Nations: Population-Based Evidence From a Western Canadian Province. Inflamm Bowel Dis 2022; 28:514-522. [PMID: 34037223 PMCID: PMC8972279 DOI: 10.1093/ibd/izab096] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is limited to no evidence of the prevalence and incidence rates of inflammatory bowel disease (IBD) among Indigenous peoples. In partnership with Indigenous patients and family advocates, we aimed to estimate the prevalence, incidence, and trends over time of IBD among First Nations (FNs) since 1999 in the Western Canadian province of Saskatchewan. METHODS We conducted a retrospective population-based study linking provincial administrative health data from the 1999-2000 to 2016-2017 fiscal years. An IBD case definition requiring multiple health care contacts was used. The prevalence and incidence data were modeled using generalized linear models and a negative binomial distribution. Models considered the effect of age groups, sex, diagnosis type (ulcerative colitis [UC], Crohn disease [CD]), and fiscal years to estimate prevalence and incidence rates and trends over time. RESULTS The prevalence of IBD among FNs increased from 64/100,000 (95% confidence interval [CI], 62-66) in 1999-2000 to 142/100,000 (95% CI, 140-144) people in 2016-2017, with an annual average increase of 4.2% (95% CI, 3.2%-5.2%). Similarly, the prevalence of UC and CD, respectively, increased by 3.4% (95% CI, 2.3%-4.6%) and 4.1% (95% CI, 3.3%-4.9%) per year. In contrast, the incidence rates of IBD, UC, and CD among FNs depicted stable trends over time; no statistically significant changes were observed in the annual change trend tests. The ratio of UC to CD was 1.71. CONCLUSIONS We provided population-based evidence of the increasing prevalence and stable incidence rates of IBD among FNs. Further studies are needed in other regions to continue understanding the patterns of IBD among Indigenous peoples.
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Affiliation(s)
- Juan Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jose Diego Marques Santos
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Derek Jennings
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mustafa Andkhoie
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Germain Bukassa-Kazadi
- Health Surveillance and Assessment Unit Service, Department of Indigenous Services Canada, Regina, Saskatchewan, Canada
| | - Xinya Lu
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Michelle Johnson-Jennings
- Department of Indigenous Studies, College of Arts and Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Rob Porter
- York Factory First Nation, Manitoba, Canada
| | - Carol-Lynne Quintin
- Crohn’s and Colitis Canada, Saskatchewan Chapter, Saskatoon, Saskatchewan, Canada
| | | | - Ulrich Teucher
- Department of Psychology, College of Arts and Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sharyle Fowler
- Division of Gastroenterology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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12
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Peña-Sánchez JN, Osei JA, Rohatinsky N, Lu X, Risling T, Boyd I, Wicks K, Wicks, M, Quintin CL, Dickson A, Fowler SA. OUP accepted manuscript. J Can Assoc Gastroenterol 2022; 6:55-63. [PMID: 37025513 PMCID: PMC10071297 DOI: 10.1093/jcag/gwac015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Rural dwellers with inflammatory bowel disease (IBD) face barriers to accessing specialized health services. We aimed to contrast health care utilization between rural and urban residents diagnosed with IBD in Saskatchewan, Canada. Methods We completed a population-based retrospective study from 1998/1999 to 2017/2018 using administrative health databases. A validated algorithm was used to identify incident IBD cases aged 18+. Rural/urban residence was assigned at IBD diagnosis. Outpatient (gastroenterology visits, lower endoscopies, and IBD medications claims) and inpatient (IBD-specific and IBD-related hospitalizations, and surgeries for IBD) outcomes were measured after IBD diagnosis. Cox proportional hazard, negative binomial, and logistic models were used to evaluate associations adjusting by sex, age, neighbourhood income quintile, and disease type. Hazard ratios (HR), incidence rate ratios (IRR), odds ratios (OR), and 95% confidence intervals (95% CI) were reported. Results From 5,173 incident IBD cases, 1,544 (29.8%) were living in rural Saskatchewan at IBD diagnosis. Compared to urban dwellers, rural residents had fewer gastroenterology visits (HR = 0.82, 95% CI: 0.77-0.88), were less likely to have a gastroenterologist as primary IBD care provider (OR = 0.60, 95% CI: 0.51-0.70), and had lower endoscopies rates (IRR = 0.92, 95% CI: 0.87-0.98) and more 5-aminosalicylic acid claims (HR = 1.10, 95% CI: 1.02-1.18). Rural residents had a higher risk and rates of IBD-specific (HR = 1.23, 95% CI: 1.13-1.34; IRR = 1.22, 95% CI: 1.09-1.37) and IBD-related (HR = 1.20, 95% CI: 1.11-1.31; IRR = 1.23, 95% CI: 1.10-1.37) hospitalizations than their urban counterparts. Conclusion We identified rural-urban disparities in IBD health care utilization that reflect rural-urban inequities in the access to IBD care. These inequities require attention to promote health care innovation and equitable management of patients with IBD living in rural areas.
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Affiliation(s)
- Juan Nicolás Peña-Sánchez
- Correspondence: Juan Nicolás Peña-Sánchez, MD, MPH, PhD, Room 3232—E-Wing Health Sciences, 104 Clinic Place, Saskatoon, SK S7N5E5, Canada, e-mail:
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada
| | | | - Xinya Lu
- Health Quality Council, Saskatchewan, Canada
| | | | | | | | | | | | | | - Sharyle A Fowler
- Department of Medicine, College of Medicine, University Saskatchewan, Canada
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13
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Jones JL, Benchimol EI, Bernstein CN, Huang JG, Marshall JK, Mukhtar MS, Murthy SK, Nguyen GC, Kaplan GG, Kuenzig ME, Tandon P, Targownik LE, Windsor JW, Bitton A. Crohn's and Colitis Canada's 2021 Impact of COVID-19 and Inflammatory Bowel Disease in Canada: Health Care Delivery During the Pandemic and the Future Model of Inflammatory Bowel Disease Care. J Can Assoc Gastroenterol 2021; 4:S61-S67. [PMID: 34755041 PMCID: PMC8570426 DOI: 10.1093/jcag/gwab034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022] Open
Abstract
The SARS-CoV-2 pandemic has had a profound impact on inflammatory bowel disease (IBD) health care delivery. The implementation of necessary public health restrictions has restricted access to medications, procedures and surgeries throughout the pandemic, catalyzing widespread change in how IBD care is delivered. Rapid large-scale implementation of virtual care modalities has been shown to be feasible and acceptable for the majority of individuals with IBD and health care providers. The SARS-CoV-2 pandemic has exacerbated pre-existing barriers to accessing high-quality, multidisciplinary IBD care that addresses health care needs holistically. Continued implementation and evaluation of both synchronous and asynchronous eHealthcare modalities are required now and in the future in order to determine how best to incorporate these modalities into patient-centred, collaborative care models. Resources must be dedicated to studies that evaluate the feasibility, acceptability and effectiveness of eHealth-enhanced models of IBD care to improve efficiency and cost-effectiveness, while increasing quality of life for persons living with IBD. Crohn's and Colitis Canada will continue to play a major leadership role in advocating for the health care delivery models that improve the quality of life for persons living with IBD.
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Affiliation(s)
- Jennifer L Jones
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - James Guoxian Huang
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John K Marshall
- Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mariam S Mukhtar
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sanjay K Murthy
- The Ottawa Hospital IBD Centre, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Geoffrey C Nguyen
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Parul Tandon
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alain Bitton
- Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Patients' perspectives on medication for inflammatory bowel disease: a mixed-method systematic review. Eur J Gastroenterol Hepatol 2021; 33:1139-1147. [PMID: 32773507 DOI: 10.1097/meg.0000000000001861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Inflammatory bowel disease (IBD) is a lifelong chronic disease that frequently requires long-term medical treatment to maintain remission. Patient perspectives on IBD medication are important to understand as nonadherence to IBD medication is common. We aim to synthesize the evidence about patients' perspectives on medication for IBD. A mixed-method systematic review was conducted on Scopus, EMBASE, Web of Science, and CINAHL. The convergent integrated approach to synthesis and integration of qualitative and quantitative findings was used for data analysis. Twenty-five articles from 20 countries were included in this review (20 quantitative, 3 qualitative, and 2 mixed-method studies). Patients have identified a lack of knowledge in the areas of efficacy, side effects, and characteristics of medications as key elements. Some negative views on IBD medication may also be present (e.g. the high number of pills and potential side effects). Lack of knowledge about medication for IBD was identified as a common issue for patients. Health services delivery for IBD should take into consideration these patients' perspectives. A focus on improving patient education in these areas could help empower patients and alleviate doubts resulting in better disease management and improved healthcare outcomes.
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Barreiro-de Acosta M, Gutiérrez A, Zabana Y, Beltrán B, Calvet X, Chaparro M, Domènech E, Esteve M, Panés J, Gisbert JP, Nos P. Inflammatory bowel disease integral care units: Evaluation of a nationwide quality certification programme. The GETECCU experience. United European Gastroenterol J 2021; 9:766-772. [PMID: 34089303 PMCID: PMC8435246 DOI: 10.1002/ueg2.12105] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background One of the most valued targets in inflammatory bowel disease (IBD) is for physicians to provide and patients to receive a high‐level quality of care. This study aimed to evaluate the implementation of a nationwide quality certification programme for IBD units. Methods Identification of quality indicators (QI) for IBD Unit certification was based on Delphi methodology that selected 53 QI, which were subjected to a normalisation process. Selected QI were then used in the certification process. Coordinated by GETECCU, this process began with a consulting round and an audit drill followed by a formal audit carried out by an independent certifying agency. This audit involved the scrutiny of the selected QI in medical records. If 80%–90% compliance was achieved, the IBD unit audited received the qualification of “advanced”, and if it exceeded 90% the rating was “excellence”. Afterwards, an anonymous survey was conducted among certified units to assess satisfaction with the programme for IBD units. Results As of January 2021, 66 IBD units adhere to the nationwide certification programme. Among the 53 units already audited by January 2021, 31 achieved the certification of excellence, 20 the advanced certification, and two did not obtain the certification. The main survey results indicated high satisfaction with an average score of 8.5 out of 10. Conclusion Certification of inflammatory bowel disease units by GETECCU is the largest nationwide certification programme for IBD units reported. More than 90% of IBD units adhered to the programme achieved the certification.
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Affiliation(s)
| | - Ana Gutiérrez
- Hospital General Universitario Alicante, Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitari Mútua Terrassa, Terrasa, Spain
| | - Belén Beltrán
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Corporació Sanitaria Universitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Maria Esteve
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitari Mútua Terrassa, Terrasa, Spain
| | - Julian Panés
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Pilar Nos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Hospital Universitario y Politécnico La Fe, Valencia, Spain
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16
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Ding Z, Patel A, Izanec J, Pericone CD, Lin JH, Baugh CW. Trends in US emergency department visits and subsequent hospital admission among patients with inflammatory bowel disease presenting with abdominal pain: a real-world study from a national emergency department sample database. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2021; 9:1912924. [PMID: 33968334 PMCID: PMC8079064 DOI: 10.1080/20016689.2021.1912924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/16/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
Background/Objective: This study evaluated emergency department (ED) visit trends, subsequent inpatient admissions for patients with inflammatory bowel disease (IBD) diagnosis and IBD-related abdominal pain (AP), and hospital-level variation in inpatient admission rates in the USA (US). Methods: This population-based, cross-sectional study included data from Nationwide Emergency Department Sample (NEDS, 2006─2013) database. Patients ≥18 years of age with primary ED diagnosis of IBD/IBD-related AP were included. Variables included demographics, insurance information, household income, Quan-Charlson comorbidity score, ED discharge disposition, and length of hospital stay (2006, 2010, and 2013). Variation between hospitals using risk-adjusted admission ratio was estimated. Results: Annual ED visits for IBD/100,000 US population increased (30 in 2006 vs 42 in 2013, p = 0.09), subsequent admissions remained stable (20 in 2006 vs 23 in 2013, p = 0.52). ED visits for IBD-related AP increased by 71% (7 in 2006 vs 12 in 2013; p = 0.12), subsequent admissions were stable (0.50 in 2006 vs 0.58 in 2013; p = 0.88). Proportion of patients with subsequent hospitalization decreased (IBD: 65.7% to 55.7%; IBD-related AP: 6.9% to 4.9%). Variation in subsequent inpatient admissions was 1.42 (IBD) and 1.96 (IBD-related AP). Conclusions: An increase in annual ED visits was observed for patients with IBD and IBD-related AP; however, subsequent inpatient admission rate remained stable.
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Affiliation(s)
- Zhijie Ding
- Janssen Scientific Affairs, Janssen Pharmaceuticals, Horsham, PA, USA
| | - Aarti Patel
- Janssen Scientific Affairs, Janssen Pharmaceuticals, Titusville, NJ, USA
| | - James Izanec
- Janssen Scientific Affairs, Janssen Pharmaceuticals, Horsham, PA, USA
| | | | - Jennifer H. Lin
- Janssen Scientific Affairs, Janssen Pharmaceuticals, Titusville, NJ, USA
| | - Christopher W. Baugh
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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17
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Osei JA, Peña-Sánchez JN, Fowler SA, Muhajarine N, Kaplan GG, Lix LM. Increasing Prevalence and Direct Health Care Cost of Inflammatory Bowel Disease Among Adults: A Population-Based Study From a Western Canadian Province. J Can Assoc Gastroenterol 2021; 4:296-305. [PMID: 34877469 PMCID: PMC8643630 DOI: 10.1093/jcag/gwab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/03/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Our study aimed to calculate the prevalence and estimate the direct health care costs of inflammatory bowel disease (IBD), and test if trends in the prevalence and direct health care costs of IBD increased over two decades in the province of Saskatchewan, Canada. Methods We conducted a retrospective population-based cohort study using administrative health data of Saskatchewan between 1999/2000 and 2016/2017 fiscal years. A validated case definition was used to identify prevalent IBD cases. Direct health care costs were estimated in 2013/2014 Canadian dollars. Generalized linear models with generalized estimating equations tested the trend. Annual prevalence rates and direct health care costs were estimated along with their 95% confidence intervals (95%CI). Results In 2016/2017, 6468 IBD cases were observed in our cohort; Crohn’s disease: 3663 (56.6%), ulcerative colitis: 2805 (43.4%). The prevalence of IBD increased from 341/100,000 (95%CI 340 to 341) in 1999/2000 to 664/100,000 (95%CI 663 to 665) population in 2016/2017, resulting in a 3.3% (95%CI 2.4 to 4.3) average annual increase. The estimated average health care cost for each IBD patient increased from $1879 (95%CI 1686 to 2093) in 1999/2000 to $7185 (95%CI 6733 to 7668) in 2016/2017, corresponding to an average annual increase of 9.5% (95%CI 8.9 to 10.1). Conclusions Our results provide relevant information and analysis on the burden of IBD in Saskatchewan. The evidence of the constant increasing prevalence and health care cost trends of IBD needs to be recognized by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.
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Affiliation(s)
- Jessica Amankwah Osei
- Department of Community Health and Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sharyle A Fowler
- Department of Medicine, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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18
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Polidano K, Chew-Graham CA, Farmer AD, Saunders B. Access to Psychological Support for Young People Following Stoma Surgery: Exploring Patients' and Clinicians' Perspectives. QUALITATIVE HEALTH RESEARCH 2021; 31:535-549. [PMID: 33228473 PMCID: PMC7802047 DOI: 10.1177/1049732320972338] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Psychological problems are common among people with inflammatory bowel disease (IBD) following stoma surgery. However, the ways in which stoma-related psychological needs are identified and addressed in health care settings remain unexplored. In this study, we investigated the perspectives of young people with a stoma and health care professionals about access to psychological support. Semi-structured interviews were conducted with young people with an IBD stoma (18-29 years, n = 13) and health care professionals (n = 15), including colorectal surgeons, gastroenterologists, specialist nurses in IBD and stoma care, and general practitioners in England. Data collection and analysis were informed by constructivist grounded theory. Three analytic categories were developed: "initiating support-seeking," "affirming psychological needs," and "mobilizing psychological support," which capture young peoples' trajectory to access psychological support. Based on the findings, we highlight the need for both patients and health care professionals to assign greater priority to the identification of psychological symptoms post-stoma surgery. More effective care pathways, which include responsive psychological services, would enhance access to psychological support for young people with a stoma.
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Affiliation(s)
- Kay Polidano
- School of Medicine, Keele University, Keele, United Kingdom
| | - Carolyn A. Chew-Graham
- School of Medicine, Keele University, Keele, United Kingdom
- Midlands Partnership Foundation Trust, Stafford, United Kingdom
| | - Adam D. Farmer
- School of Medicine, Keele University, Keele, United Kingdom
- University Hospitals of North Midlands NHS Trust, Stoke-on Trent, United Kingdom
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19
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Rohatinsky N, Risling T, Hellsten LAM, Kumaran M. Inflammatory Bowel Disease Nurses' Perspectives: Prioritizing Adolescent Transition Readiness Factors. J Pediatr Nurs 2020; 55:29-39. [PMID: 32634732 DOI: 10.1016/j.pedn.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Despite the wealth of knowledge and expertise that Inflammatory Bowel Disease (IBD) nurses bring to the transition process, health literature lacks nurses' perspectives on transition readiness. The purpose of study was to ask IBD nurses to prioritize care transition readiness factors for adolescents living with IBD. DESIGN AND METHODS The cross-sectional exploratory survey was researcher-developed and distributed online to IBD nurses across Canada. The survey was divided into nine transition topic categories. RESULTS Fifty-six female registered nurses from six Canadian provinces participated in the study. Overall, nurses rated all items within each transition topic category to be very important in facilitating adolescent transition to adult healthcare. The highest individual mean scores and the highest prioritized categories were within the Knowing IBD and Healthcare Provider Relationships categories, emphasizing the importance for adolescents to understand their disease and feel comfortable communicating their needs and questions to healthcare providers. CONCLUSIONS The transition process needs to be individualized and comprehensive addressing a multitude of biopsychosocial factors in order to support IBD patients and families to achieve healthy adult self-care behaviours that can foster positive health outcomes. PRACTICE IMPLICATIONS Healthcare providers, adolescents, and parents must work collaboratively to achieve identified transition goals so that the transition process is a mutually satisfying experience. A comprehensive readiness assessment tool is suggested to assist in the transition process. Transition readiness assessment must start early, be ongoing, be age-appropriate, and be individualized to the patient needs.
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Affiliation(s)
| | - Tracie Risling
- College of Nursing, University of Saskatchewan, SK, Canada.
| | - Laurie-Ann M Hellsten
- Department of Educational Psychology and Special Education, College of Education, University of Saskatchewan, SK, Canada.
| | - Maha Kumaran
- Education & Music Library, University of Saskatchewan, SK, Canada.
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20
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GORAN L, STATE M, NEGREANU A, NEGREANU L. Quality of Care in Inflammatory Bowel Disease: the Role of Steroid Assessment Tool (SAT) - a Review. MEDICINA MODERNA - MODERN MEDICINE 2020; 27:171-176. [DOI: 10.31689/rmm.2020.27.3.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Corticosteroids have an important role in induction of remission in inflammatory bowel disease, but they are not an indicated for maintenance treatment as they are associated with many side effects. Despite new effi cient therapeutic options for maintaining remission, there is an excess in prescribing steroids in inflammatory bowel disease. Corticosteroid use was evaluated in international cohorts given that steroid free remission and avoiding serious side-effects of corticosteroids is a desirable goal. We discuss the role and the evidences on a secure web-based steroid assessment tool (SAT) which can be used as an instrument of evaluation of corticosteroid use, a quality indicator in inflammatory bowel disease.
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Affiliation(s)
- Loredana GORAN
- 2nd Department of Gastroenterology, Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica STATE
- 2nd Department of Gastroenterology, Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ana NEGREANU
- 2nd Department of Gastroenterology, Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian NEGREANU
- 2nd Department of Gastroenterology, Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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21
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Osei JA, Peña-Sánchez JN, Fowler SA, Muhajarine N, Kaplan GG, Lix LM. Population-Based Evidence From a Western Canadian Province of the Decreasing Incidence Rates and Trends of Inflammatory Bowel Disease Among Adults. J Can Assoc Gastroenterol 2020; 4:186-193. [PMID: 34337319 PMCID: PMC8320288 DOI: 10.1093/jcag/gwaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022] Open
Abstract
Background and Aims Canada has one of the highest inflammatory bowel disease (IBD) incidence rates worldwide. Higher IBD incidence rates have been identified among urban regions compared to rural regions. The study objectives were to (i) estimate IBD incidence rates in Saskatchewan from 1999 to 2016 and (ii) test for differences in IBD incidence rates for rural and urban regions of Saskatchewan. Methods A population-based study was conducted using provincial administrative health databases. Individuals aged 18+ years with newly diagnosed Crohn's disease or ulcerative colitis were identified using a validated case definition. Generalized linear models with a negative binomial distribution were used to estimate incidence rates and incidence rate ratios (IRRs) adjusted for age group, sex and rurality with 95% confidence intervals (CIs). Results The average annual incidence rate of IBD among adults in Saskatchewan decreased from 75/100,000 (95% CI 67 to 84) in 1999 to 15/100,000 (95% CI 12 to 18) population in 2016. The average annual incidence of IBD declined significantly by 6.9% (95% CI -7.6 to -6.2) per year. Urban residents had a greater overall risk of IBD (IRR = 1.19, 95% CI 1.11 to 1.27) than rural residents. This risk difference was statistically significant for Crohn's disease (IRR = 1.25, 95% CI 1.14 to 1.36), but not for ulcerative colitis (IRR = 1.08, 95% CI 0.97 to 1.19). Conclusions The incidence of IBD in Saskatchewan dropped significantly from 1999 to 2016 with urban dwellers having a 19% higher risk of IBD onset compared to their rural counterparts. Health care providers and decision-makers should plan IBD-specific health care programs considering these specific IBD rates.
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Affiliation(s)
- Jessica Amankwah Osei
- Department of Community Health & Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health & Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sharyle A Fowler
- Division of Gastroenterology, Department of Medicine, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nazeem Muhajarine
- Department of Community Health & Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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22
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Ben Nessib D, Ferjani H, Maatallah K, Rahmouni S, Kaffel D, Hamdi W. Update on therapeutic management of spondyloarthritis associated with inflammatory bowel disease. Clin Rheumatol 2020; 39:3543-3553. [PMID: 32424656 DOI: 10.1007/s10067-020-05136-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
Management of spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) remains a challenging task that requires multidisciplinary collaboration. Separate guidelines for each disease are well-established. However, the management of SpA co-occurring with Crohn's disease (CD) or ulcerative colitis (UC) has hardly been studied. There are few specific reports that focus on this therapeutic area. The main issue is that some therapeutic options used to treat one disease can negatively influence the other disease course. This study aims to evaluate the therapeutic alternatives that would allow for the appropriate management of patients with both SpA and IBD. Key Points • Collaboration between gastroenterologists and rheumatologists is recommended to improve the management of patients with spondyloarthritis (SpA) and inflammatory bowel disease (IBD). • When treating SpA occurring simultaneously with IBD, it would be appropriate to give priority to the active disease. • Considering its well-proven efficacy in both conditions, anti-tumor necrosis factor (TNF) therapy remains the corner stone in the treatment of these patients. • Other therapeutic options such as Janus kinases (JAK) inhibitors, interleukin (IL)-23 and IL-12 inhibitors, and vedolizumab are still under investigation.
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Affiliation(s)
- Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia. .,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia. .,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia.
| | - Hanene Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
| | - Safa Rahmouni
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
| | - Dhia Kaffel
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, Ksar Said, 2010, Tunis, Tunisia
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23
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Coto P, Riestra S, Rozas P, Señaris A, Queiro R. Improving the standard of care for patients with spondyloarthritis-related immune inflammatory conditions: results of a Delphi study and proposal for early detection. Ther Adv Chronic Dis 2020; 11:2040622320904295. [PMID: 32110287 PMCID: PMC7016300 DOI: 10.1177/2040622320904295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Our objective was to provide consensus recommendations on the optimal management of the immune-mediated inflammatory diseases (IMIDs) seen in patients with spondyloarthritis (SpA) using a multidisciplinary approach, and to develop a simple tool to help earlier recognition and referral of coexisting IMIDs in patients who already have one type of IMID. Methods A total of 28 experts in the multidisciplinary management of the SpA-associated IMIDs assessed two questionnaires: one with statements focused on the multidisciplinary management of IMIDs, and a second questionnaire focused on questions useful for early recognition and referral. Panelists assessed the statements with a 9-point ordinal scale (1 = strongly disagree, 9 = strongly agree) using a modified Delphi methodology. Results Consensus was reached on 72 out of the 82 statements (87.8%). Panelists agreed that the multidisciplinary approach to IMIDs is not sufficiently developed. The creation of multidisciplinary IMID units might be necessary. These units might focus primarily on patients with two or more coexisting IMIDs, or on IMIDs that are especially complex from a diagnostic or therapeutic point of view. Specialists who attend to patients with IMIDs should perform a screening for other coexisting IMIDs. A simple tool to help earlier recognition and referral of coexisting IMIDs is proposed. Conclusions There is a need to improve care for patients with SpA-associated IMIDs. We provide expert recommendations to guide the adoption of a multidisciplinary approach for these cases, and a simple tool that may be useful for earlier recognition of coexisting IMIDs.
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Affiliation(s)
- Pablo Coto
- Dermatology Division, Hospital Vital Alvarez Buylla, Mieres-Asturias, Spain
| | - Sabino Riestra
- Gastroenterology Service, IBD Unit, Hospital Universitario Central de Asturias, Oviedo-Asturias, Spain
| | - Paloma Rozas
- Ophthalmology Service, Hospital Universitario Central de Asturias, Oviedo-Asturias, Spain
| | - Ana Señaris
- Ophthalmology Service, Hospital Universitario Central de Asturias, Oviedo-Asturias, Spain
| | - Rubén Queiro
- Rheumatology Division, Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA), Av. Roma, s/n, Oviedo-Asturias, 33011, Spain
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24
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Coward S, Clement F, Benchimol EI, Bernstein CN, Avina-Zubieta JA, Bitton A, Carroll MW, Hazlewood G, Jacobson K, Jelinski S, Deardon R, Jones JL, Kuenzig ME, Leddin D, McBrien KA, Murthy SK, Nguyen GC, Otley AR, Panaccione R, Rezaie A, Rosenfeld G, Peña-Sánchez JN, Singh H, Targownik LE, Kaplan GG. Past and Future Burden of Inflammatory Bowel Diseases Based on Modeling of Population-Based Data. Gastroenterology 2019; 156:1345-1353.e4. [PMID: 30639677 DOI: 10.1053/j.gastro.2019.01.002] [Citation(s) in RCA: 309] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/03/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Inflammatory bowel diseases (IBDs) exist worldwide, with high prevalence in North America. IBD is complex and costly, and its increasing prevalence places a greater stress on health care systems. We aimed to determine the past current, and future prevalences of IBD in Canada. METHODS We performed a retrospective cohort study using population-based health administrative data from Alberta (2002-2015), British Columbia (1997-2014), Manitoba (1990-2013), Nova Scotia (1996-2009), Ontario (1999-2014), Quebec (2001-2008), and Saskatchewan (1998-2016). Autoregressive integrated moving average regression was applied, and prevalence, with 95% prediction intervals (PIs), was forecasted to 2030. Average annual percentage change, with 95% confidence intervals, was assessed with log binomial regression. RESULTS In 2018, the prevalence of IBD in Canada was estimated at 725 per 100,000 (95% PI 716-735) and annual average percent change was estimated at 2.86% (95% confidence interval 2.80%-2.92%). The prevalence in 2030 was forecasted to be 981 per 100,000 (95% PI 963-999): 159 per 100,000 (95% PI 133-185) in children, 1118 per 100,000 (95% PI 1069-1168) in adults, and 1370 per 100,000 (95% PI 1312-1429) in the elderly. In 2018, 267,983 Canadians (95% PI 264,579-271,387) were estimated to be living with IBD, which was forecasted to increase to 402,853 (95% PI 395,466-410,240) by 2030. CONCLUSION Forecasting prevalence will allow health policy makers to develop policy that is necessary to address the challenges faced by health systems in providing high-quality and cost-effective care.
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Affiliation(s)
- Stephanie Coward
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Calgary, Calgary, Alberta, Canada
| | | | - Eric I Benchimol
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; Children's Hospital of Eastern Ontario IBD Centre and CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Charles N Bernstein
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Manitoba, Winnipeg, Manitoba, Canada
| | - J Antonio Avina-Zubieta
- Arthritis Research Canada, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alain Bitton
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; McGill University, Montreal, Quebec, Canada
| | - Mathew W Carroll
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Alberta, Edmonton, Alberta, Canada
| | | | - Kevan Jacobson
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; British Columbia Children's Hospital, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Jelinski
- University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
| | - Rob Deardon
- University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - M Ellen Kuenzig
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; Children's Hospital of Eastern Ontario IBD Centre and CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Desmond Leddin
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Limerick, Limerick, Ireland
| | | | - Sanjay K Murthy
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Ottawa, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada; The Ottawa Hospital Research Institute and IBD Centre, Ottawa, Ontario, Canada
| | - Geoffrey C Nguyen
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; ICES, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Anthony R Otley
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Ali Rezaie
- Cedar Sinai Medical Center, Los Angeles, California
| | - Greg Rosenfeld
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; Arthritis Research Canada, University of British Columbia, Vancouver, British Columbia, Canada
| | - Juan Nicolás Peña-Sánchez
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Harminder Singh
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gilaad G Kaplan
- Canadian Gastro-Intestinal Epidemiology Consortium, Canada; University of Calgary, Calgary, Alberta, Canada.
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25
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Reinglas J, Restellini S, Gonczi L, Kurti Z, Verdon C, Nene S, Kohen R, Afif W, Bessissow T, Wild G, Seidman E, Bitton A, Lakatos PL. Harmonization of quality of care in an IBD center impacts disease outcomes: Importance of structure, process indicators and rapid access clinic. Dig Liver Dis 2019; 51:340-345. [PMID: 30591367 DOI: 10.1016/j.dld.2018.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We aimed to evaluate the quality of care at a tertiary inflammatory bowel disease (IBD) center using quality of care indicators (QIs) including patient assessment strategy, monitoring, treatment decisions and outcomes. METHODS We retrospectively reviewed the quality of care pre- and post-referral and during follow-up at the at the McGill University Health Center (MUHC) IBD center. Consecutive patients were included presenting with an outpatient visit ('index visit') between July and December 2016. Disease characteristics, biochemistry, imaging and endoscopy data, changes in medications, and vaccination profiles were captured. RESULTS 1357 patients were included. At referral, a large proportion of patients were objectively re-evaluated (ileocolonoscopy: 79%, cross-sectional imaging: 39.3%, biomarkers: 89.9%, 81.9%). Therapeutic strategy was changed in 53.6% with 22.5% of patients starting biologics. Tight objective patient monitoring was applied during follow-up (colonoscopy: 79%, cross-sectional imaging: 61.8% were available at index visit; C-reactive protein: 78%, Faecal calprotectin: 37.6%, therapeutic drug monitoring: 16.3% were performed additionally). Maximum therapeutic step was biologicals in 48.8% of the patients, while only 6.6% of all patients were steroid dependent. Implementation of a rapid access clinic improved healthcare delivery. CONCLUSIONS Our data support that tight monitoring was applied at the MUHC IBD center with a high emphasis on objective patient (re)evaluation, timely access and accelerated treatment strategy at referral and during follow-up.
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Affiliation(s)
- Jason Reinglas
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Sophie Restellini
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada; Division of Gastroenterology and Hepatology, Geneva's University Hospitals and University of Geneva, Switzerland
| | - Lorant Gonczi
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Christine Verdon
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Sofia Nene
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Rita Kohen
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Waqqas Afif
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Talat Bessissow
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Gary Wild
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Ernest Seidman
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Alain Bitton
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Peter L Lakatos
- Inflammatory Bowel Disease Centre, Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada; 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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Schoenfeld R, Nguyen GC, Bernstein CN. Integrated Care Models: Optimizing Adult Ambulatory Care in Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2018; 3:44-53. [PMID: 34169226 PMCID: PMC8218536 DOI: 10.1093/jcag/gwy060] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic, complex and unpredictable disease affecting an increasing number of patients worldwide from a young age. Inflammatory bowel disease is associated with multiple comorbidities and complications, requiring ongoing preventative, acute and chronic care. The purpose of this article is to review the literature on outpatient care models used to treat adults with IBD and to gain insight on how to improve quality of care and reduce costs. Methods A comprehensive review of recent literature on PubMed, Scopus and Google Scholar databases about care models used to treat IBD was performed. Key terms included ‘inflammatory bowel disease’, ‘organizational models’, ‘patient care team’ and ‘quality improvement’. Results Studies showed that an integrated care model decreases hospital admissions, IBD-related surgeries and comorbidities of IBD, ultimately decreasing direct and indirect costs of IBD compared with a more traditional patient-physician model. A gastroenterologist-led multidisciplinary team (MDT) involving comprehensive care by IBD nurses, a surgeon, psychologist, dietician, pharmacist, and other members as needed is recommended. Conclusions A holistic approach to IBD care delivered by a MDT with structured monitoring, active follow-up, patient education and prompt access to care improves outcomes for IBD patients. More research is needed on the cost-effectiveness of integrated care models to demonstrate long-term value and secure funding for implementation. Future research should compare integrated models of care and assess patient and physician satisfaction in these models of delivering IBD care.
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Affiliation(s)
- Roberta Schoenfeld
- Faculty of Graduate Studies, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey C Nguyen
- Department of Medicine, University of Toronto, Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Charles N Bernstein
- Faculty of Graduate Studies, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, and Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Strohl M, Gonczi L, Kurt Z, Bessissow T, L Lakatos P. Quality of care in inflammatory bowel diseases: What is the best way to better outcomes? World J Gastroenterol 2018; 24:2363-2372. [PMID: 29904243 PMCID: PMC6000296 DOI: 10.3748/wjg.v24.i22.2363] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a lifelong, progressive disease that has disabling impacts on patient's lives. Given the complex nature of the diagnosis of IBD and its management there is consequently a large economic burden seen across all health care systems. Quality indicators (QI) have been created to assess the different façades of disease management including structure, process and outcome components. Their development serves to provide a means to target and measure quality of care (QoC). Multiple different QI sets have been published in IBD, but all serve the same purpose of trying to achieve a standard of care that can be attained on a national and international level, since there is still a major variation in clinical practice. There have been many recent innovative developments that aim to improve QoC in IBD including telemedicine, home biomarker assessment and rapid access clinics. These are some of the novel advancements that have been shown to have great potential at improving QoC, while offloading some of the burden that IBD can have vis-a-vis emergency room visits and hospital admissions. The aim of the current review is to summarize and discuss available QI sets and recent developments in IBD care including telemedicine, and to give insight into how the utilization of these tools could benefit the QoC of IBD patients. Additionally, a treating-to-target structure as well as evidence surrounding aggressive management directed at tighter disease control will be presented.
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Affiliation(s)
- Matthew Strohl
- Division of Gastroenterology, McGill University Health Center, Montreal, Québec H4A 3J1, Canada
| | - Lorant Gonczi
- First Department of Medicine, Semmelweis University, Koranyi, Budapest 1083, Hungary
| | - Zsuzsanna Kurt
- First Department of Medicine, Semmelweis University, Koranyi, Budapest 1083, Hungary
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Center, Montreal, Québec H4A 3J1, Canada
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Center, Montreal, Québec H4A 3J1, Canada
- First Department of Medicine, Semmelweis University, Koranyi, Budapest 1083, Hungary
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Mathias H, van Zanten SV, Kits O, Heisler C, Jones J. Patient-ly Waiting: A Review of Patient-Centered Access to Inflammatory Bowel Disease Care in Canada. J Can Assoc Gastroenterol 2018; 1:26-32. [PMID: 31294393 PMCID: PMC6487989 DOI: 10.1093/jcag/gwy001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Canada has one of the highest prevalence estimates of inflammatory bowel disease (IBD) in the world. Like other chronic illnesses, access to specialist care is required for disease management. Traditionally, access to care is evaluated through wait times (actual access); however, new patient-oriented definitions of access (perceived access) highlight other equally important facets of access to care (e.g., appropriateness). Aim: How does access to gastroenterology speciality care influence disease-related outcomes for IBD patients in Canada? A comprehensive literature review was undertaken. Cochrane, PubMed and CINHAL databases were searched for peer-reviewed English language articles published between 2006 and 2016. Inclusion/exclusion criteria focussed on access to IBD care in Canada. Included articles were classified using Levesque et al.’s patient-centered access framework (e.g., affordability, accessibility, appropriateness, acceptability, availability and accommodation). Eight articles were found, including six which addressed patient-centered access. Most of the articles addressed issues of availability (e.g., wait times), appropriateness and affordability. Only one article addressed approachability and acceptability of IBD care. All articles emphasized a need for greater patient-centered measures (e.g., multidisciplinary clinics) with a goal to improve patient access and, ultimately, patient outcomes. Understanding patient-centered access to IBD care is important for managing IBD and improving patient outcomes. Literature examining access to gastroenterology services is limited. Increased investment in patient-oriented research should be made to better understand the relationship between access to specialist care and patient outcomes.
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Affiliation(s)
- Holly Mathias
- Nova Scotia Collaborative IBD Program, Division of Digestive Care and Endoscopy, QEII Health Sciences Centre, Centre for Clinical Research, Halifax, NS
| | - Sander Veldhuyzen van Zanten
- Division of Gastroenterology, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, NW, Edmonton, AB
| | - Olga Kits
- Research Methods Unit, Nova Scotia Health Authority, Centre for Clinical Research Building, Halifax, NS
| | - Courtney Heisler
- Nova Scotia Collaborative IBD Program, Division of Digestive Care and Endoscopy, QEII Health Sciences Centre, Centre for Clinical Research, Halifax, NS
| | - Jennifer Jones
- Nova Scotia Collaborative IBD Program, Division of Digestive Care and Endoscopy, QEII Health Sciences Centre, Centre for Clinical Research, Halifax, NS
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