Quality of care in patients with inflammatory bowel disease from a public health center in Brazil

Table 1 Socio-demographic and clinical characteristics of patients with inflammatory bowel disease

	IBD (n = 133)	Crohn’s disease (n = 69)	Ulcerative colitis (n = 64)	P value2
Age (yr)	37.26 ± 13.05	37.06 ± 12.75	37.48 ± 13.46	0.8515
Female gender, n (%)	85 (63.91)	38 (55.07)	47 (73.44)	0.0276
Family income (BRL)	2240.11 ± 1216.62	2.436.60 ± 1374.45	2237.12 ± 1023.55	0.3092
Marital status, n (%)				0.5349
Married	71 (53.38)	34 (49.28)	37 (27.82)
Single	51 (38.35)	28 (40.58)	1 (1.56)
Widowed	4 (3.00)	3 (4.35)	23 (35.94)
Separated/Divorced	7 (5.26)	4 (5.80)	3 (4.69)
Employment situation, n (%)				0.9394
Employed	78 (58.65)	40 (57.97)	38 (59.38)
Unemployed	21 (15.79)	11 (15.94)	10 (15.63)
Student	6 (4.51)	4 (5.80)	2 (3.13)
Medical leave	5 (3.75)	2 (2.90)	3 (4.69)
Housewife	13 (9.77)	6 (8.70)	7 (10.94)
Retired	10 (7.52)	6 (8.70)	4 (6.25)
Years of study, n (%)				0.5247
≤ 5	5 (3.79)	2 (2.90)	3 (4.69)
5 < X ≤ 9	12 (9.02)	4 (4.80)	8 (12.50)
9 < X ≤ 12	66 (49.63)	35 (50.73)	31 (48.44)
> 12	50 (36.58)	28 (30.14)	22 (34.37)
Social economic Stratum1, n (%)				0.4626
A	6 (4.88)	5 (7.69)	1 (1.72)
B	66 (53.66)	34 (52.31)	32 (55.17)
C	44 (35.77)	23 (35.38)	21 (36.21)
D	7 (5.69)	3 (4.62)	4 (6.90)
Comorbidities, n (%)	42 (31.58)	19 (27.54)	23 (35.94)	0.2977
Smoking, n (%)	6 (4.51)	5 (7.25)	1 (1.56)	0.0623
Alcohol use, n (%)	7 (2.27)	5 (7.35)	2 (3.13)	0.4649
Internet access, n (%)	121 (90.98)	66 (95.65)	55 (85.94)	0.0507

¹Brazil Social Economic Stratum (Brazilian Market Research Association, 2015). Social economic Stratum: A (20888 BRL/mo), B1 (9254 BRL/mo), B2 (4852 BRL/mo), C1 (2705 BRL/mo), C2 (1625 BRL/mo), D (768 BRL/mo).

²P value (Crohn’s disease vs ulcerative colitis).

Data are expressed as mean ± SD or frequency (proportion). IBD: Inflammatory bowel disease; BRL: Brazilian currency.

Table 2 Clinical characteristics of patients with Crohn’s disease and ulcerative colitis

	IBD (n = 133)	Crohn’s disease (n = 69)	Ulcerative colitis (n = 64)	P value1
Time since diagnosis (years)	8.44 ± 7.59	9.64 ± 9.02	7.14 ± 5.45	0.0171
Disease extent, n (%)
Proctitis			13 (20.31)
Left-sided colitis			17 (26.56)
Extensive/Pancolitis			34 (53.13)
Montreal classification
Age at diagnosis, n (%)
A1 (< 17 years)		16 (23.19)
A2 (17-40 years)		46 (66.67)
A3 (> 40 years)		7 (10.14)
Disease location, n (%)
L1 (ileal)		16 (23.19)
L2 (colonic)		9 (13.04)
L3 (ileocolonic)		44 (63.77)
Disease behavior, n (%)
B1 (non-stricturing, non-penetrating)		24 (34.78)
B2 (stricturing)		25 (36.23)
B3 (penetrating)		20 (28.99)
Perianal disease, n (%)		28 (40.58)
Disease activity, n (%)
Remission		43 (62.32)	45 (70.31)
Mild		13 (18.84)	1 (1.56)
Moderate		10 (14.49)	13 (20.31)
Severe		3 (4.35)	5 (7.81)
Partial Mayo score (points)			2.14 ± 2.72
CDAI score (points)		140.63 ± 112.48
Medications in use, n (%)
Mesalazine	31 (23.31)	1 (1.45)	30 (46.88)	< 0.0001
Azathioprine	65 (48.87)	42 (60.87)	23 (35.94)	0.0041
Corticosteroid	9 (6.77)	3 (4.35)	6 (9.38)	0.2488
Infliximab	45 (33.83)	31 (44.93)	14 (21.88)	0.0050
Adalimumab	20 (15.04)	14 (20.29)	6 (9.38)	0.0785
Certolizumabe pegol	1 (0.75)	1 (1.45)	-	-
No medication	4 (3.01)	2 (2.90)	2 (3.13)	1.0000
Previous hospitalization, n (%)	31 (23.31)	47 (68.12)	30 (46.88)	0.0132
Number of previous hospitalizations	0.79 ± 1.24	1.02 ± 1.46	0.55 ± 0.91	0.0061
Previous surgery, n (%)	44 (33.08)	37 (53.62)	7 (10.94)	< 0.0001
Number of previous surgeries	0.56 ± 1.19	0.98 ± 1.50	0.14 ± 0.50	< 0.0001
Presence of ostomy, n (%)	14 (10.53)	11 (15.94)	3 (4.69)	0.0471

¹P value (Crohn’s disease vs ulcerative colitis).

Data are expressed as mean ± SD or frequency (proportion). IBD: Inflammatory bowel disease; CDAI: Crohn’s disease activity index.

Table 3 Assessment of quality of life, anxiety and depression, and self-esteem of patients with inflammatory bowel disease

	IBD (n = 133)	Crohn’s disease (n = 69)	Ulcerative colitis (n = 64)	P value2
Quality of life (IBDQ)1, n (%)				0.0469
Excellent	25 (18.94)	12 (17.65)	13 (20.31)
Good	60 (45.45)	38 (55.88)	22 (34.38)
Regular	32 (24.24)	14 (20.59)	18 (28.13)
Poor	15 (11.36)	4 (5.88)	11 (17.19)
IBDQ score (points)
Bowel function	52.61 ± 13.62	55.21 ± 11.49	49.84 ± 15.18	0.0427
Systemic symptoms	22.17 ± 7.19	23.12 ± 7.25	21.16 ± 7.05	0.1177
Social function	26.62 ± 8.22	27.51 ± 7.67	25.67 ± 8.72	0.2653
Emotional status	58.34 ± 16.84	60.88 ± 14.96	55.64 ± 18.36	0.0737
Total score	159.73 ± 42.72	166.72 ± 38.56	152.31 ± 45.88	0.0524
SF-36 (points)
Physical aspects	60.34 ± 42.77	64.49 ± 40.31	55.86 ± 45.15	0.5028
Physical function	72.22 ± 29.31	77.90 ± 24.78	66.09 ± 32.62	0.1216
Bodily pain	49.70 ± 8.34	50.00 ± 8.91	49.38 ± 7.74	0.6677
General health	54.66 ± 19.67	56.16 ± 19.02	53.05 ± 20.37	0.3638
Mental health	60.12 ± 22.07	64.64 ± 21.35	55.25 ± 21.95	0.0137
Vitality	52.44 ± 22.78	56.01 ± 22.86	48.59 ± 22.23	0.0602
Emotional aspects	60.15 ± 43.90	63.29 ± 42.06	56.77 ± 45.88	0.5176
Social function	47.37 ± 15.24	49.82 ± 14.46	44.73 ± 15.72	0.0538
SF-36 total score	57.13 ± 18.09	60.29 ± 17.36	53.71 ± 18.39	0.0511
Presence of anxiety, n (%)	53 (40.46)	21 (30.88)	32 (50.79)	0.0203
Presence of depression, n (%)	38 (29.01)	19 (27.94)	19 (30.16)	0.7799
Anxiolytic and antidepressant use, n (%)	31 (23.30)	12 (17.39)	19 (29.69)	0.0938
Psychological monitoring, n (%)	21 (15.79)	5 (7.25)	16 (25.0)	0.0050
Self-esteem scale, n (%)				0.5120
Low self-esteem	5 (3.76)	2 (2.90)	3 (4.69)
Medium self-esteem	19 (14.29)	12 (17.39)	7 (10.94)
High self-esteem	109 (81.95)	55 (79.71)	54 (84.38)
Routine limitation by IBD, n (%)	65 (48.87)	31 (44.93)	34 (53.31)	0.3447
Trust in medical treatment, n (%)	119 (89.47)	63 (91.30)	56 (87.50)	0.4750

¹n = 68 patients with Crohn’s disease.

²P value (Crohn’s disease vs ulcerative colitis).

Data are expressed as mean ± SD or frequency (proportion). IBD: Inflammatory bowel disease; IBDQ: Inflammatory Bowel Disease Questionnaire; SF-36: 36-Item Short Form Survey.

Table 4 Quality of Care Through the Eyes of Patients with Inflammatory Bowel Disease questionnaire category and total care scores, and satisfaction with care in patients with inflammatory bowel disease

	IBD (n = 133)	Crohn’s disease (n = 69)	Ulcerative colitis (n = 64)	P value1
Score of QUOTE-IBD categories
Accessibility	8.31 ± 1.65	8.58 ± 1.55	8.02 ± 1.71	0.0498
Accommodation	7.83 ± 3.25	8.28 ± 2.85	7.25 ± 3.57	0.0456
Autonomy	9.37 ± 2.08	9.42 ± 1.94	9.31 ± 2.23	0.7665
Competence	8.78 ± 1.79	8.99 ± 1.69	8.56 ± 1.89	0.1734
Continuity of care	8.05 ± 2.36	8.52 ± 1.91	7.55 ± 2.69	0.0186
Courtesy	9.27 ± 1.31	9.43 ± 1.24	9.09 ± 1.37	0.1256
Cost	9.48 ± 1.93	9.64 ± 1.59	9.31 ± 2.22	0.3385
Information	8.65 ± 2.02	9.05 ± 1.63	8.22 ± 2.31	0.0189
QUOTE-IBD Total Care	8.61 ± 1.31	8.92 ± 1.16	8.27 ± 1.38	0.0042
Satisfaction according to QUOTE-IBD categories, n (%)
Accessibility	55 (41.35)	32 (46.38)	23 (35.94)	0.2219
Accommodation	86 (64.66)	49 (71.01)	37 (57.81)	0.1115
Autonomy	121 (90.98)	63 (91.30)	58 (90.63)	0.8913
Competence	87 (65.41)	49 (71.01)	38 (59.38)	0.1585
Continuity of care	66 (49.62)	38 (55.07)	28 (43.75)	0.1919
Courtesy	97 (72.93)	55 (79.71)	42 (65.63)	0.0677
Cost	123 (92.48)	65 (94.20)	58 (90.63)	0.5203
Information	81 (60.90)	49 (71.01)	32 (50.00)	0.0131
QUOTE-IBD Total Care, n (%)	69 (51.88)	44 (63.77)	25 (39.06)	0.0044

¹P value (Crohn’s disease vs ulcerative colitis).

Data are expressed as mean ± SD or frequency (proportion). Test T and Chi Square test. QUOTE-IBD: Quality of Care Through the Eyes of Patients with Inflammatory Bowel Disease; IBD: Inflammatory bowel disease.

Table 5 Clinical-, quality of life-, and psychological-related variables and Quality of Care Through the Eyes of Patients with Inflammatory Bowel Disease total care in patients with inflammatory bowel disease

	Correlation co-efficient (R)	P value
Age (yr)	-0.0080	0.9240
Female gender	0.1647	0.0581
Family income (BRL)1	-0.0060	0.9480
Time since diagnosis (yr)	0.0770	0.3760
Disease (ulcerative colitis vs Crohn’s disease)	-0.2467	0.0042
CDAI (points)	-0.0320	0.7920
Partial Mayo score (points)	-0.0630	0.6200
Disease activity (no vs yes)	-0.0284	0.7454
Medication in use (no vs yes)
Mesalazine	-0.1702	0.0501
Azathioprine	0.1032	0.2369
Corticosteroid	-0.0567	0.5169
Infliximab	0.2223	0.0101
Adalimumab	-0.0223	0.7988
Certolizumab	0.02904	0.7400
Previous hospitalization (no vs yes)	0.1364	0.1172
Previous surgery (no vs yes)	0.1179	0.1762
Psychological monitoring (no vs yes)	-0.0294	0.7366
Infusion center consultation	0.1577	0.0698
Time of travel to the IBD center (h)	0.0090	0.9190
Waiting time for consultation (h)	-0.2670	0.0040
IBDQ score (points)
Bowel function	0.0790	0.3660
Systemic symptoms	0.1560	0.0740
Social function	0.0020	0.9820
Emotional status	0.0200	0.8220
Total score	0.0600	0.4970
SF-36 Questionnaire (points)
Physical aspects	0.0980	0.2620
Physical function	0.0830	0.3430
Bodily pain	-0.0630	0.4700
General health	-0.0020	0.9840
Mental health	0.0760	0.3840
Vitality	0.1040	0.2340
Emotional aspects	0.1200	0.1700
Social function	-0.0200	0.8190
Total score	0.1040	0.2340
HADS Anxiety (points)	-0.0750	0.3930
HADS Depression (points)	-0.0600	0.4990
Self-esteem scale (points)	0.0820	0.3490

¹BRL: Brazilian currency.

Correlation co-efficient (R) values determined via Pearson’s correlation test. QUOTE-IBD: Quality of Care Through the Eyes of Patients with Inflammatory Bowel Disease; CDAI: Crohn’s Disease Activity Index; IBDQ: Inflammatory bowel disease questionnaire; SF-36: 36-Item Short-Form Health Survey; HADS: Hospital Anxiety and Depression Scale.

Table 6 Univariate logistic regression between clinical-, quality of life-, and psychological-related variables and satisfaction with care (according to Quality of Care Through the Eyes of Patients with Inflammatory Bowel Disease results) in patients with inflammatory bowel disease

	Odds Ratio	95% Confidence Interval	P value
Age (yr)	0.997	0.971-1.024	0.8292
Gender (female vs male)	0.582	0.284-1.195	0.1402
Family income (BRL)	1.000	1.000-1.000	0.7521
Time since diagnosis (years)	1.061	0.971-1.064	0.4914
Crohn’s vs ulcerative colitis	2.746	1.360-5.541	0.0048
CDAI (points)	0.999	0.995-1.004	0.7725
Partial Mayo score (points)	0.941	0.777-1.141	0.5375
Disease activity (yes vs no)	0.834	0.407-1.713	0.6216
Medication in use (yes vs no)
Mesalazine	0.417	0.181-0.960	0.0399
Azathioprine	1.487	0.750-2.946	0.2559
Corticosteroid	0.439	0.105-1.836	0.2598
Infliximab	2.175	1.037-4.562	0.0398
Adalimumab	1.159	0.446-3.012	0.7620
Previous hospitalization (yes vs no)	1.653	0.826-3.309	0.1555
Previous surgery (yes vs no)	2.368	1.118-5.015	0.0243
Psychological monitoring (yes vs no)	0.311	0.112-0.861	0.0245
Infusion center consultation (yes vs no)	1.643	0.793-3.404	0.1817
Time of travel to the IBD center (hours)	0.996	0.687-1.444	0.9822
Waiting time for consultation (hours)	0.713	0.525-0.969	0.0370
Stress while waiting for consultation (yes vs no)	0.485	0.241-0.973	0.0418
IBDQ score (points)
Bowel function	1.018	0.992-1.044	0.1814
Systemic symptoms	1.069	1.016-1.125	0.0097
Social function	1.024	0.982-1.068	0.2635
Emotional status	1.016	0.995-1.037	0.1435
Total score	1.007	0.999-1.015	0.0980
SF-36 Questionnaire (points)
Physical aspects	1.007	0.999-1.016	0.0770
Physical function	1.010	0.998-1.022	0.1094
Bodily pain	1.005	0.964-1.047	0.8225
General health	1.001	0.984-1.019	0.8709
Mental health	1.012	0.997-1.028	0.1249
Vitality	1.012	0.996-1.027	0.1358
Emotional aspects	1.008	1.000-1.016	0.0569
Social function	0.998	0.975-1.020	0.8334
Total score	1.019	0.999-1.039	0.0572
Anxiety (yes vs no)	0.765	0.380-1.540	0.4535
HADS Anxiety (points)	0.939	0.873-1.009	0.0881
Depression (yes vs no)	1.087	0.511-2.315	0.8279
HADS Depression (points)	0.966	0.898-1.039	0.3501
Self-esteem scale (points)	1.024	0.991-1.059	0.1583

QUOTE-IBD: Quality of Care Through the Eyes of Patients with Inflammatory Bowel Disease; CDAI: Crohn’s Disease Activity Index; IBDQ: Inflammatory bowel disease questionnaire; SF-36: Medical Outcomes Study 36-Item Short-Form Health Survey; HADS: Hospital anxiety and depression scale.