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Adamina M, Minozzi S, Warusavitarne J, Buskens CJ, Chaparro M, Verstockt B, Kopylov U, Yanai H, Vavricka SR, Sigall-Boneh R, Sica GS, Reenaers C, Peros G, Papamichael K, Noor N, Moran GW, Maaser C, Luglio G, Kotze PG, Kobayashi T, Karmiris K, Kapizioni C, Iqbal N, Iacucci M, Holubar S, Hanzel J, Sabino JG, Gisbert JP, Fiorino G, Fidalgo C, Ellu P, El-Hussuna A, de Groof J, Czuber-Dochan W, Casanova MJ, Burisch J, Brown SR, Bislenghi G, Bettenworth D, Battat R, Atreya R, Allocca M, Agrawal M, Raine T, Gordon H, Myrelid P. ECCO Guidelines on Therapeutics in Crohn's Disease: Surgical Treatment. J Crohns Colitis 2024; 18:1556-1582. [PMID: 38878002 DOI: 10.1093/ecco-jcc/jjae089] [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: 05/21/2024] [Indexed: 07/28/2024]
Abstract
This article is the second in a series of two publications on the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn's disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn's disease and an update of prior ECCO Guidelines.
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Affiliation(s)
- Michel Adamina
- Department of Surgery, Cantonal Hospital of Fribourg & Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | | | - Maria Chaparro
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-Princesa], Universidad Autónoma de Madrid [UAM], Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - Bram Verstockt
- Department Gastroenterology & Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
| | - Henit Yanai
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Rotem Sigall-Boneh
- Pediatric Gastroenterology and Nutrition Unit, The E. Wolfson Medical Center, Holon, Israel
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology and Metabolism, University of Amsterdam, Amsterdam, The Netherlands
| | - Giuseppe S Sica
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology and Metabolism, University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Università Tor Vergata, Roma, Italy
| | | | - Georgios Peros
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nurulamin Noor
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Gordon William Moran
- National Institute of Health Research Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals, Nottingham, UK
- Translational Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christian Maaser
- Outpatients Department of Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | - Gaetano Luglio
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Paulo Gustavo Kotze
- Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná [PUCPR], Curitiba, Brazil
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | | | | | - Nusrat Iqbal
- Department of Surgery, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Marietta Iacucci
- APC Microbiome Ireland, College of Medicine and Health, University College of Cork, Cork, Ireland
| | - Stefan Holubar
- Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jurij Hanzel
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - João Guedelha Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-Princesa], Universidad Autónoma de Madrid [UAM], Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | | | - Catarina Fidalgo
- Division of Gastroenterology, Hospital Beatriz Ângelo, Loures Division of Gastroenterology, Hospital da Luz, Lisboa, Portugal
| | - Pierre Ellu
- Division of Gastroenterology, Mater Dei Hospital, l-Msida, Malta
| | - Alaa El-Hussuna
- OpenSourceResearch Organization [OSRC.Network], Aalborg, Denmark
| | - Joline de Groof
- Colorectal Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing-Midwifery and Palliative Care, King's College London, London, UK
| | - María José Casanova
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-Princesa], Universidad Autónoma de Madrid [UAM], Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | | | | | - Dominik Bettenworth
- CED Schwerpunktpraxis, Münster and Medical Faculty of the University of Münster, Münster, Germany
| | - Robert Battat
- Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Raja Atreya
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Mariangela Allocca
- IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Gastroenterology and Endoscopy, Milan, Italy
| | - Manasi Agrawal
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Tim Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hannah Gordon
- Translational Gastroenterology and Liver Unit, Gastroenterology Office, University of Oxford, Oxford, UK
| | - Pär Myrelid
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Takamune DM, Cury GSA, Ferrás G, Herrerias GSP, Rivera A, Barros JR, Baima JP, Saad-Hossne R, Sassaki LY. Quality of care in patients with inflammatory bowel disease from a public health center in Brazil. World J Clin Cases 2022; 10:12184-12199. [PMID: 36483811 PMCID: PMC9724505 DOI: 10.12998/wjcc.v10.i33.12184] [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: 07/20/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBDs) are chronic diseases that demand continuous interaction between patients and healthcare providers. Quality of care (QoC) is a factor that contributes to a patient's adherence to treatment and its success. AIM To evaluate QoC in patients from a single IBD reference center. METHODS This cross-sectional study included 133 patients from a single Brazilian IBD public health center. QoC was evaluated through the QoC Through the Eyes of Patients with IBD (QUOTE-IBD) questionnaire (based on patient perspectives), which measures eight dimensions of care. We compared QoC among patients with Crohn's disease and ulcerative colitis and analyzed the clinical and psychological factors associated with QoC satisfaction. Clinical evaluations assessed disease characteristics, quality of life, anxiety, and depression levels. RESULTS Sixty-nine patients with Crohn's disease and 64 with ulcerative colitis were interviewed. The mean age was 37.26 years ± 13.05 years, and 63.91% of the patients were women. The mean duration of the disease was 8.44 years ± 7.59 years, where most patients were in remission (70.31% of patients with ulcerative colitis and 62.32% with Crohn's disease). The total QoC score of the sample was 8.61 years ± 1.31 points, indicating that the QoC provided by the center was unsatisfactory. According to univariate logistic regression, patients with Crohn's disease had higher satisfaction rates than those with ulcerative colitis [odds ratio (OR): 2.746; 95% confidence interval (CI): 1.360-5.541; P = 0.0048] and patients on infliximab (OR: 2.175; 95%CI: 1.037-4.562; P = 0.0398). CONCLUSION Patients from the IBD public center reported good doctor-patient relationships, but had problems related to the healthcare structure. Evaluation of healthcare centers is of paramount to improve QoC for the patients involved.
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Affiliation(s)
- Debora Mayumi Takamune
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618686, São Paulo, Brazil
| | | | - Giulia Ferrás
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618686, São Paulo, Brazil
| | - Giedre Soares Prates Herrerias
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618686, São Paulo, Brazil
| | - Adriana Rivera
- Research Unit, Virgen Macarena University Hospital, Seville 41009, Spain
| | - Jaqueline Ribeiro Barros
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618686, São Paulo, Brazil
| | - Julio Pinheiro Baima
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618686, São Paulo, Brazil
- Department of Medicine, Nove de Julho University, Bauru 17011-102, São Paulo, Brazil
| | - Rogerio Saad-Hossne
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu 18618686, São Paulo, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618686, São Paulo, Brazil
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Calvet X, Panés J, Gallardo-Escudero J, de la Cuadra-Grande A, Bartolomé E, Marín L, de la Portilla F, Navarro-Correal E, Gutiérrez A, Nos P, Serrano R, Casado MÁ, Barreiro-de Acosta M. Multicriteria Decision Analysis for Updating of Quality Indicators for Inflammatory Bowel Disease Comprehensive Care Units in Spain. J Crohns Colitis 2022; 16:1663-1675. [PMID: 35551380 PMCID: PMC9683078 DOI: 10.1093/ecco-jcc/jjac068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Management of inflammatory bowel disease [IBD] is complex and IBD Comprehensive Care Units [ICCUs] facilitate the delivery of quality care to IBD patients. The objective of this study was to update the existing set of quality indicators [QIs] for ICCUs, based on a nationwide quality certification programme carried out in Spain, from a multi-stakeholder perspective and using multicriteria decision analysis [MCDA] methodology. METHODS An MCDA comprising three different phases was conducted. In phase 1, a systematic literature review was performed, and after validation by a scientific committee comprising 11 experts, a preliminary set of QIs was developed. In phase 2, a larger group of 49 experts determined the relevance and relative importance of each QI by prioritising and weighing the preliminary set. Finally in phase 3, the scientific committee reviewed the results and made a final selection via a deliberative process. RESULTS The final set comprised 67 QIs, classified as Structure [23 QIs], Process [35 QIs] and Outcome [9 QIs], which were ranked according to their relative importance. Multidisciplinary management was the most important requirement in ICCUs, followed by continuity of care, standardisation of clinical care and, especially, the incorporation of patients' reported outcomes. CONCLUSIONS This updated set of QIs comprises a weighted and prioritised set of items that represent the essential minimum of criteria for ensuring appropriate quality of care in the management of IBD patients.
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Affiliation(s)
- Xavier Calvet
- Servei d’Aparell Digestiu, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julián Panés
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Gastroenterology Department, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Javier Gallardo-Escudero
- Health Economics Department, Pharmacoeconomics & Outcomes Research Iberia [PORIB], Madrid, Spain
| | | | | | - Laura Marín
- Gastroenterology and Hepatology Department, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - Fernando de la Portilla
- General Surgery and Digestive System Clinical Management Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Ana Gutiérrez
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Gastroenterology Department, Hospital General de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante [ISABIAL], Alicante, Spain
| | - Pilar Nos
- Gastroenterology Unit, Hospital Universitario La Fe, Valencia, Spain
| | - Ruth Serrano
- Confederación de Asociaciones de Crohn y Colitis Ulcerosa, Madrid, Spain
| | - Miguel Ángel Casado
- Health Economics Department, Pharmacoeconomics & Outcomes Research Iberia [PORIB], Madrid, Spain
| | - Manuel Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Adamina M, Fiorino G. At the Crossroads of Caution and Intervention: Anti-TNF Therapy Prior to Elective CD Surgery. J Crohns Colitis 2021; 15:1778-1779. [PMID: 33999192 DOI: 10.1093/ecco-jcc/jjab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Michel Adamina
- Department of Surgery, Colorectal Surgery Unit, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Winterthur, Switzerland.,Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
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Choe MY, VanGraafeiland B, Parian A. Improving Follow-ups With Gastroenterologists Utilizing an Appointment Scheduling Protocol in Inflammatory Bowel Disease: A Quality Improvement Project. Gastroenterol Nurs 2021; 44:E91-E100. [PMID: 34411015 DOI: 10.1097/sga.0000000000000635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022] Open
Abstract
Approximately one in four patients with inflammatory bowel disease are readmitted within 90 days. To reduce hospitalizations, regular follow-up appointments with gastroenterologists are essential. However, the mean wait time for gastroenterology clinic appointments significantly exceeded the target goal of 14 days in North America. Based on literature review, we developed and implemented a new appointment scheduling protocol. The inclusion criteria were adult patients with inflammatory bowel disease who were recently hospitalized or newly referred to a gastroenterology clinic. At weeks 0 and 12, wait times were extrapolated from chart review, and patient satisfaction rates were collected via surveys. Patient demographics and outcome data were examined using descriptive statistics. A total of 16 patients were included. Following the intervention, the mean wait time decreased from 40.4 (SD = 31.9) to 21.9 days (SD = 11.4), but the change was statistically insignificant (p = .408). Poor response rates (47%) limited the interpretation of the patient satisfaction data. Despite the small sample size, our project was the first quality improvement initiative that implemented an evidence-based appointment scheduling protocol among adult patients with inflammatory bowel disease. Further studies are warranted with a larger sample size to better evaluate its efficacy in achieving timely outpatient gastroenterology care.
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Affiliation(s)
- Monica Y Choe
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Brigit VanGraafeiland
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alyssa Parian
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Assessing adherence to objective disease monitoring and outcomes with adalimumab in a real-world IBD cohort. Dig Liver Dis 2021; 53:980-986. [PMID: 33640302 DOI: 10.1016/j.dld.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data suggests that tight objective monitoring may improve clinical outcomes in IBD. AIM To assess the adherence to serial tight objective monitoring(clinical and biomarkers) and its effect on clinical outcomes. METHODS We retrospectively reviewed the chart of 428 consecutive IBD patients started on adalimumab between January 1,2015-January 1,2019 [338 Crohn's disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms(assessed by Harvey-Bradshaw-Index,partial Mayo),C-Reactive Protein(CRP), and fecal calprotectin(FCAL) assessments were captured at treatment initiation and at 3,6,9, and12 months. Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method. RESULTS Clinical evaluation was available in nearly all patients at 3(CD-UC:95-94%), 6(90-83%), 9(86-85%) and 12(96-89%) months. CRP testing frequency decreased in CD patients over time. Compliance to serial FCAL testing was low. Clinical remission at one-year was higher in patients adherent to early assessment visit at 3 months(p = 0.001 for CD and UC). Adherence to early follow-up resulted in earlier dose optimization in CD and UC patients(pLogrank=0.026 for UC & p = 0.09 for CD). Overall drug sustainability did not differ. CONCLUSION Clinical & CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization, improved one-year clinical outcomes but did not change drug sustainability.
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Choe MY, Wright R, Parian A. Follow-up Care in Inflammatory Bowel Disease: An Integrative Review. Gastroenterol Nurs 2021; 44:E48-R58. [PMID: 34037572 DOI: 10.1097/sga.0000000000000570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023] Open
Abstract
Inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract and is associated with high risks for complications, surgeries, and frequent hospitalizations. Approximately one in four inflammatory bowel disease patients are readmitted to the hospital within 90 days of discharge in the United States. Although existing literature showed a timely clinic appointment with gastroenterologists is a protective factor for disease flare-ups and hospitalizations, the follow-up appointments were found to be either lacking or significantly delayed. Further, evidence-based guidelines in timely inflammatory bowel disease care are lacking. Thus, this integrative review examined current literature to identify effective strategies for achieving timely clinic appointments with gastroenterologists in inflammatory bowel disease. A comprehensive search of three electronic databases (PubMed, Embase, and Cumulative Index of Nursing and Allied Health Literature [CINAHL] Plus) was conducted from January 2009 to September 2019 using the key terms: inflammatory bowel disease, ulcerative colitis, Crohn's disease, appointments, and time to appointment. Nine articles met the inclusion criteria. The main interventions for timely inflammatory bowel disease care included (i) clinic-wide scheduling protocols, (ii) a dedicated healthcare team, (iii) efficient referral process, (iv) appointment management based on disease acuity and severity, and (v) addressing shortage of inflammatory bowel disease clinicians. Further research is needed to quantify the magnitude of timely inflammatory bowel disease care interventions with controls and evaluate the efficacy with a head-to-head trial. Through timely referrals, evaluations, and treatments, these quality improvement endeavors will ultimately improve quality of care and contribute to reduction in preventable hospitalizations and associated healthcare costs from delayed outpatient inflammatory bowel disease care.
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Affiliation(s)
- Monica Y Choe
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rebecca Wright
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alyssa Parian
- Monica Y. Choe, DNP, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Rebecca Wright, PhD, BSc (Hons), RN, is Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Assistant Professor of Medicine, Associate Clinical Director of Gastroenterology & Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Sarabia S, Farrer C, Yeung J, Jerome D, Cook RJ, Eder L. Comparative Efficacy of Different Triage Methods for Psoriatic Arthritis - Prospective Study in a Rapid Access Clinic. Arthritis Care Res (Hoboken) 2021; 74:1254-1262. [PMID: 33544974 DOI: 10.1002/acr.24570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/04/2020] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The study aimed to identify the optimal combination of triage methods to identify PsA among psoriasis patients with musculoskeletal symptoms in a rapid access clinic and to describe their outcome after 1 year. METHODS Patients with psoriasis and no prior diagnosis of PsA were referred for assessment of their musculoskeletal complaints. Each patient was assessed by the following three triage modalities: 1) assessment by an advanced practice physiotherapist; 2) targeted musculoskeletal ultrasound (MSK-US) and; 3) PsA screening questionnaires. The patients were then evaluated by a rheumatologist who determined their disease status and classified them as: "Not PsA", "Possibly PsA" or "PsA". Patients returned for a one year follow up visit and were re-assessed for change in their disease status. Sensitivity and specificity were calculated for each individual modality as well as for combinations of modalities. RESULTS 203 patients with psoriasis and musculoskeletal symptoms were enrolled. 8.8% were classified as PsA and 23.6% as possibly PsA. There was no significant difference in the individual performance of the modalities. The highest sensitivity was seen with MSK-US (89%) and the highest specificity was found with the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire (79%). The addition of MSK-US data improved the performance of the modalities. A total of 9 patients converted to PsA after 1 year. All patient reported outcome measures have significantly improved at one year (P<0.001). CONCLUSION Combining MSK-US with a screening questionnaire for PsA improved the triage of patients with suspected PsA.
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Affiliation(s)
| | - Chandra Farrer
- Division of Rheumatology, Women's College Hospital and the Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Women's College Hospital and the Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dana Jerome
- Division of Rheumatology, Women's College Hospital and the Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard J Cook
- Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital and the Department of Medicine, University of Toronto, Toronto, ON, Canada
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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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Nene S, Gonczi L, Kurti Z, Morin I, Chavez K, Verdon C, Reinglas J, Kohen R, Bessissow T, Afif W, Wild G, Seidman E, Bitton A, Lakatos PL. Benefits of implementing a rapid access clinic in a high-volume inflammatory bowel disease center: Access, resource utilization and outcomes. World J Gastroenterol 2020; 26:759-769. [PMID: 32116423 PMCID: PMC7039829 DOI: 10.3748/wjg.v26.i7.759] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/29/2019] [Accepted: 01/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emergency situations in inflammatory bowel diseases (IBD) put significant burden on both the patient and the healthcare system.
AIM To prospectively measure Quality-of-Care indicators and resource utilization after the implementation of the new rapid access clinic service (RAC) at a tertiary IBD center.
METHODS Patient access, resource utilization and outcome parameters were collected from consecutive patients contacting the RAC between July 2017 and March 2019 in this observational study. For comparing resource utilization and healthcare costs, emergency department (ED) visits of IBD patients with no access to RAC services were evaluated between January 2018 and January 2019. Time to appointment, diagnostic methods, change in medical therapy, unplanned ED visits, hospitalizations and surgical admissions were calculated and compared.
RESULTS 488 patients (Crohn’s disease: 68.4%/ulcerative colitis: 31.6%) contacted the RAC with a valid medical reason. Median time to visit with an IBD specialist following the index contact was 2 d. Patients had objective clinical and laboratory assessment (C-reactive protein and fecal calprotectin in 91% and 73%). Fast-track colonoscopy/sigmoidoscopy was performed in 24.6% of the patients, while computed tomography/magnetic resonance imaging in only 8.1%. Medical therapy was changed in 54.4%. ED visits within 30 d following the RAC visit occurred in 8.8% (unplanned ED visit rate: 5.9%). Diagnostic procedures and resource utilization at the ED (n = 135 patients) were substantially different compared to RAC users: Abdominal computed tomography was more frequent (65.7%, P < 0.001), coupled with multiple specialist consults, more frequent hospital admission (P < 0.001), higher steroid initiation (P < 0.001). Average medical cost estimates of diagnostic procedures and services per patient was $403 CAD vs $1885 CAD comparing all RAC and ED visits.
CONCLUSION Implementation of a RAC improved patient care by facilitating easier access to IBD specific medical care, optimized resource utilization and helped avoiding ED visits and subsequent hospitalizations.
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Affiliation(s)
- Sofia Nene
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Lorant Gonczi
- First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
| | - Isabelle Morin
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Kelly Chavez
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Jason Reinglas
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Rita Kohen
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Gary Wild
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Ernest Seidman
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
| | - Peter Laszlo Lakatos
- First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
- Division of Gastroenterology, McGill University Health Centre, Quebec, Montreal H3G1A4, Canada
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11
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Adamina M, Bonovas S, Raine T, Spinelli A, Warusavitarne J, Armuzzi A, Bachmann O, Bager P, Biancone L, Bokemeyer B, Bossuyt P, Burisch J, Collins P, Doherty G, El-Hussuna A, Ellul P, Fiorino G, Frei-Lanter C, Furfaro F, Gingert C, Gionchetti P, Gisbert JP, Gomollon F, González Lorenzo M, Gordon H, Hlavaty T, Juillerat P, Katsanos K, Kopylov U, Krustins E, Kucharzik T, Lytras T, Maaser C, Magro F, Marshall JK, Myrelid P, Pellino G, Rosa I, Sabino J, Savarino E, Stassen L, Torres J, Uzzan M, Vavricka S, Verstockt B, Zmora O. ECCO Guidelines on Therapeutics in Crohn's Disease: Surgical Treatment. J Crohns Colitis 2020; 14:155-168. [PMID: 31742338 DOI: 10.1093/ecco-jcc/jjz187] [Citation(s) in RCA: 353] [Impact Index Per Article: 70.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn's disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn's disease and an update of previous guidelines.
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Affiliation(s)
- Michel Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- University of Basel, Basel, Switzerland
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Tim Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Antonino Spinelli
- Humanitas Clinical and Research Center, Division of Colon and Rectal Surgery, Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Janindra Warusavitarne
- Imperial College London, Department of Surgery and Cancer, St Mark's Hospital, Department of Gastroenterology, London, UK
| | - Alessandro Armuzzi
- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS - Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Oliver Bachmann
- Department of Internal Medicine I, Siloah St Trudpert Hospital, Pforzheim, Germany
| | - Palle Bager
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Livia Biancone
- Department of Systems Medicine, University 'Tor Vergata' of Rome, Rome, Italy
| | | | - Peter Bossuyt
- Imelda GI Clinical Research Centre, Imelda General Hospital, Bonheiden, Belgium
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Paul Collins
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Glen Doherty
- Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Alaa El-Hussuna
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Federica Furfaro
- IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Christian Gingert
- Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland; Department of Human Medicine, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | | | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP], Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - Fernando Gomollon
- IBD UNIT, Hospital Clíico Universitario 'Lozano Blesa', IIS Aragón, CIBEREHD, Zaragoza, Spain
| | | | - Hannah Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Tibor Hlavaty
- Fifth Department of Internal Medicine, Sub-department of Gastroenterology and Hepatology, University Hospital Bratislava and Faculty of Medicine, Comenius University Bratislava, Slovakia
| | - Pascal Juillerat
- Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Tel-HaShomer Sheba Medical Center, Ramat Gan, Israel; and Sackler Medical School, Tel Aviv, Israel
| | - Eduards Krustins
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Department of Internal Medicine, Riga Stradiņš University, Riga, Latvia
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | | | - Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Fernando Magro
- Department of Pharmacology and Therapeutics; Institute for Molecular and Cell Biology, University of Porto, Faculty of Medicine, Porto, Portugal
| | - John Kenneth Marshall
- Department of Medicine [Division of Gastroenterology] and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Pär Myrelid
- Department of Surgery, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Isadora Rosa
- Department of Gastroenterology, IPOLFG, Lisbon, Portugal
| | - Joao Sabino
- Department of Gastroenterology and Hepatology, University Hospitals, KU Leuven, Leuven, Belgium
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Laurents Stassen
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Mathieu Uzzan
- Department of Gastroenterology, IBD unit, Beaujon Hospital, APHP, Clichy, France
| | - Stephan Vavricka
- Division of Gastroenterology and Hepatology, University Hospital, Zürich, Switzerland
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and Department of Chronic Diseases, Metabolism and Ageing, TARGID - IBD, KU Leuven, Leuven, Belgium
| | - Oded Zmora
- Department of Surgery, Shamir Medical Center [Assaf Harofe], Tel Aviv, Israel
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12
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Gonczi L, Bessissow T, Lakatos PL. Disease monitoring strategies in inflammatory bowel diseases: What do we mean by "tight control"? World J Gastroenterol 2019; 25:6172-6189. [PMID: 31749591 PMCID: PMC6848014 DOI: 10.3748/wjg.v25.i41.6172] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/26/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023] Open
Abstract
In recent years, there has been a critical change in treatment paradigms in inflammatory bowel diseases (IBD) triggered by the arrival of new effective treatments aiming to prevent disease progression, bowel damage and disability. The insufficiency of symptomatic disease control and the well-known discordance between symptoms and objective measures of disease activity lead to the need of reviewing conventional treatment algorithms and developing new concepts of optimal therapeutic strategy. The treat-to-target strategies, defined by the selecting therapeutic targets in inflammatory bowel disease consensus recommendation, move away from only symptomatic disease control and support targeting composite therapeutic endpoints (clinical and endoscopical remission) and timely assessment. Emerging data suggest that early therapy using a treat-to-target approach and an algorithmic therapy escalation using regular disease monitoring by clinical and biochemical markers (fecal calprotectin and C-reactive protein) leads to improved outcomes. This review aims to present the emerging strategies and supporting evidence in the current therapeutic paradigm of IBD including the concepts of "early intervention", "treat-to-target" and "tight control" strategies. We also discuss the real-word experience and applicability of these new strategies and give an overview on the future perspectives and areas in need of further research and potential improvement regarding treatment targets and ("tight") disease monitoring strategies.
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Affiliation(s)
- Lorant Gonczi
- First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal H3G 1A4, Quebec, Canada
| | - Peter Laszlo Lakatos
- First Department of Medicine, Semmelweis University, Budapest H-1083, Hungary
- Division of Gastroenterology, McGill University Health Centre, Montreal H3G 1A4, Quebec, Canada
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13
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Gonczi L, Kurti Z, Verdon C, Reinglas J, Kohen R, Morin I, Chavez K, Bessissow T, Afif W, Wild G, Seidman E, Bitton A, Lakatos PL. Perceived Quality of Care is Associated with Disease Activity, Quality of Life, Work Productivity, and Gender, but not Disease Phenotype: A Prospective Study in a High-volume IBD Centre. J Crohns Colitis 2019; 13:1138-1147. [PMID: 30793162 DOI: 10.1093/ecco-jcc/jjz035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Measuring quality of care [QoC] in inflammatory bowel diseases [IBD] has become increasingly important, yet complex assessment of QoC from the patients' perspective is rare. We evaluated perceived QoC using the Quality of Care Through the Patient's Eyes-IBD [QUOTE-IBD] questionnaire, and investigated associations between QoC, disease phenotype, work productivity, and health-related quality of life [HRQoL] in a high-volume IBD centre. METHODS Consecutive patients attending McGill University Health Centre [MUHC]-IBD Centre completed the QUOTE-IBD, Short Inflammatory Bowel Disease Questionnaire [SIBDQ], IBD-Control, and Work Productivity and Activity Impairment [WPAI] questionnaires. The QUOTE-IBD comprises 23 questions, each rated by a quality impact [QI] score. QI scores were calculated for the evaluation of IBD specialists, general practitioners [GPs], and hospital care. RESULTS In all, 525 patients completed the questionnaire. Total QI scores for IBD specialists, GPs, and hospital care were 8.57, 8.70, and 8.33, respectively. The lowest QI scores were related to 'accessibility' for both IBD specialists and GPs. Female gender, current disease activity, poor HRQoL [SIBDQ score ≤50], and poor disease control [IBD-Control score <13] were associated with lower mean QI scores [p <0.001 for all]. Disease phenotype was not associated with QI scores in either Crohn's disease [CD] or ulcerative colitis [UC] [p = 0.69, p = 0.791, respectively]. An inverse correlation was found between total QI scores and work productivity loss [IBD specialist: p <0.001; GP: p = 0.004]. CONCLUSIONS Overall patient satisfaction with QoC was good; however, improving patient accessibility to care is warranted. Disease phenotype was not associated with patient satisfaction, whereas female gender, current disease activity, HRQoL, and work productivity loss were associated with patients' quality assessment, underlining that perceived QoC could be partly subjective regarding disease control and quality of life.
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Affiliation(s)
- Lorant Gonczi
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Christine Verdon
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Jason Reinglas
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Rita Kohen
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Isabelle Morin
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Kelly Chavez
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Talat Bessissow
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Waqqas Afif
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Gary Wild
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Ernest Seidman
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Alain Bitton
- Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary.,Inflammatory Bowel Disease Centre, McGill University Health Centre [MUHC], Montreal, QC, Canada
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