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Elford AT, Leong RW, Halmos EP, Morgan M, Kilpatrick K, Lewindon PJ, Gearry RB, Christensen B. IBD barriers across the continents: a continent-specific analysis - Australasia. Therap Adv Gastroenterol 2023; 16:17562848231197509. [PMID: 37701793 PMCID: PMC10493058 DOI: 10.1177/17562848231197509] [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: 05/10/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Australasia, encompassing Australia, New Zealand, and Papua New Guinea, has some of the highest prevalence's of inflammatory bowel disease (IBD) in the world. The way IBD medicine is practiced varies between and within these countries. There are numerous shared issues of IBD care between Australia and New Zealand, whereas Papua New Guinea has its' own unique set of circumstances. This review looks to explore some of the barriers to IBD care across the continent from the perspective of local IBD healthcare professionals. Barriers to IBD care that are explored include access to IBD multidisciplinary teams, provision of nutritional-based therapies, the prevalence and engagement of IBD-associated mental health disorders, access to medicine, access to endoscopy, rural barriers to care, Indigenous IBD care and paediatric issues. We look to highlight areas where improvements to IBD care across Australasia could be made as well as address research needs.
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Affiliation(s)
- Alexander T. Elford
- Royal Melbourne Hospital, Melbourne University, 300 Grattan Street, Melbourne, VIC 3050, Australia
| | - Rupert W. Leong
- Concord Repatriation Hospital, Sydney, NSW, Australia Macquarie University, Sydney, NSW, Australia
| | - Emma P. Halmos
- Alfred Health, Melbourne, VIC, Australia Monash University, Melbourne, VIC, Australia
| | - Manal Morgan
- Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Kate Kilpatrick
- Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | - Peter J. Lewindon
- Queensland Children’s Hospital, Brisbane, QLD, Australia University of Queensland, Brisbane, QLD, Australia
| | - Richard B. Gearry
- Christchurch Hospital, Christchurch, Canterbury, New Zealand University of Otago, Christchurch, Canterbury, New Zealand
| | - Britt Christensen
- Royal Melbourne Hospital, Melbourne, VIC, Australia Melbourne University, Melbourne, VIC, Australia
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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: 0] [Impact Index Per Article: 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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Hawthorne AB, Glatter J, Blackwell J, Ainley R, Arnott I, Barrett KJ, Bell G, Brookes MJ, Fletcher M, Muhammed R, Nevill AM, Segal J, Selinger CP, St. Clair Jones A, Younge L, Lamb CA, Arnott I, Barrett K, Bell G, Bhatnagar G, Blackwell J, Bloom S, Bramwell C, Brookes MJ, Burman A, Cairnes V, Crook KP, Dobson E, Epstein J, Faiz O, Feakins RM, Fletcher M, Garrick V, Keetarut K, Hawthorne AB, Lamb CA, Lee M, Meade U, Muhammed R, Murdock A, Pitney‐Hall N, Rochford A, Rowse G, Sagar P, Segal J, Selinger CP, Sleet S, St. Clair Jones A, Taylor SA, Wakeman R, Weaver S, Younge L. Inflammatory bowel disease patient-reported quality assessment should drive service improvement: a national survey of UK IBD units and patients. Aliment Pharmacol Ther 2022; 56:625-645. [PMID: 35770866 PMCID: PMC9541797 DOI: 10.1111/apt.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves. AIMS To assess patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high-quality care. METHODS Using the 2019 IBD standards as a framework, a national benchmarking tool for quality assessment in IBD was developed by IBD UK, comprising a patient survey and service self-assessment. RESULTS 134 IBD services and 9757 patients responded. Perceived quality of care was lowest in young adults and increased with age, was higher in males and those >2 years since diagnosis. No hospital services met all the national IBD standards for recommended workforce numbers. Key metrics associated with patient-reported high- quality care were: identification as a tertiary centre, patient information availability, shared decision- making, rapid response to contact for advice, access to urgent review, joint medical/surgical clinics, and access to research (all p < 0.001). Higher numbers of IBD nurse specialists in a service was strongly associated with patients receiving regular reviews and having confidence in self-management and reporting high- quality care. CONCLUSIONS This extensive patient and healthcare provider survey emphasises the importance of aspects of care less often measured by clinicians, such as communication, shared decision- making and provision of information. It demonstrates that IBD nurse specialists are crucial to meeting the needs of people living with IBD.
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Affiliation(s)
- A. Barney Hawthorne
- Department of GastroenterologyCardiff & Vale University Health BoardCardiffUK,Cardiff UniversityCardiffUK
| | | | | | | | - Ian Arnott
- Edinburgh IBD UnitWestern General HospitalEdinburghUK
| | | | | | - Matthew J. Brookes
- Department of GastroenterologyRoyal Wolverhampton NHS TrustWolverhamptonUK,Research Institute in Healthcare ScienceUniversity of WolverhamptonWolverhamptonUK
| | | | - Rafeeq Muhammed
- Department of Paediatric GastroenterologyBirmingham Children's HospitalBirminghamUK
| | - Alan M. Nevill
- Faculty of Health Education and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Jonathan Segal
- Department of GastroenterologyImperial College Healthcare NHS TrustLondonUK
| | - Christian P. Selinger
- Department of GastroenterologyLeeds Teaching Hospitals NHS TrustLeedsUK,University of LeedsLeedsUK
| | - Anja St. Clair Jones
- Department of PharmacyBrighton & Sussex University Hospitals NHS TrustBrightonUK
| | - Lisa Younge
- Department of GastroenterologySt Marks HospitalHarrowUK
| | | | - Christopher A. Lamb
- Translational & Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK,Department of GastroenterologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
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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: 6.3] [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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