Satisfaction of health care professionals managing patients with inflammatory bowel disease

Quality of care in inflammatory bowel disease: actual health service experiences fall short of the standards

BACKGROUND

Quality of care in inflammatory bowel disease (IBD) has received much attention internationally; however, the available surveys focus on health professionals rather than patients.

AIMS

To assess the experiences of healthcare for people living with IBD against established Australian IBD Standards.

METHODS

An online cross-sectional survey was conducted with Australians ≥16 years old recruited via Crohn's & Colitis Australia membership, public and private clinics and the Royal Flying Doctor Service. Participants completed a questionnaire incorporating items addressing the Australian IBD Standards 2016, the Picker Patient Experience Questionnaire, IBD Control Survey and the Manitoba Index.

RESULTS

Complete data were provided by 731 respondents (71.5% female, median age 46 years, ranging from 16 to 84 years). While the majority (74.8%) were satisfied with their IBD healthcare, the care reported did not meet the Australian IBD Standards. Overall, 32.4% had access to IBD nurses, 30.9% to a dietician and 12% to a psychologist in their treating team. Participants managed by public IBD clinics were most likely to have access to an IBD nurse (83.7%), helpline (80.7%) and research trials (37%). One third of respondents reported waiting >14 days to see a specialist when their IBD flared. Participants received enough information, mostly from medical specialists (88.8%) and IBD nurses (79.4%). However, 51% wanted to be more involved in their healthcare.

CONCLUSIONS

These data show discordance between expectations of patients and national standards with current levels of service provision, which fail to deliver equitable and comprehensive IBD care.

'Quality of Care' Standards in Inflammatory Bowel Disease: A Systematic Review

BACKGROUND

Inflammatory bowel disease [IBD] includes chronic, disabling and progressive conditions that need a complex approach and management. Although several attempts have been made to standardize the care of IBD patients, no clear definitions of a global 'standard of care' are currently available.

METHODS

We performed a systematic review of the available literature, searching for all relevant data concerning three main domains of standards of quality of care in IBD patients: structure, process and outcomes. From the literature search, 2394 abstracts were retrieved, and 62 relevant papers were included in the final review.

RESULTS

Standards of quality of care in IBD include several aspects that can be summarized in three identified domains: structure, process and outcomes. The suggested structure of an IBD Unit includes a multi-disciplinary approach, effective referral processes, improved access using helplines, and departmental guidelines/pathways with identification of measurable quality indicators. Coordinated care models which incorporate a multi-disciplinary approach, structured clinical pathways or processes for the diagnosis, monitoring and treatment of IBD, fast-track recovery from IBD surgery, designated IBD clinics, virtual clinics and telemanagement are currently considered the main standards for process, although supporting data are limited. Several consensus statements on outcomes and quality indicators have been reported, focusing on outcomes in symptoms, function and quality of life restoration, survival and disease control, in addition to effective healthcare utilization.

CONCLUSIONS

The results of this systematic review can provide the basis for general recommendations for standards of quality of care in IBD.

Patient-reported healthcare expectations in inflammatory bowel diseases

BACKGROUND

Patient-reported experience is an important component of a holistic approach to quality of care. Patients' expectations of treatments and global disease management may indicate their illness representations and their satisfaction and hopes regarding quality of care.

OBJECTIVE

To study expectations of patients with inflammatory bowel disease.

METHODS

Two focus groups were conducted with 14 patients to explore their expectations about treatments and disease management. From qualitative content analyses of focus group discussions, we built a 22-item expectations questionnaire that was sent to 1756 patients of the Swiss IBD cohort. Answers were collected on a visual analog scale from 0 to 100, and medians (interquartile range [IQR]) calculated. Factor analysis identified main expectation dimensions, and multivariate analyses were performed to describe associations with patient characteristics.

RESULTS

Of 1094 patients (62%) included in the study, 54% were female, 54% had Crohn's disease, 35% had tertiary education, and 72% were employed. Expectation dimensions comprised realistic, predictive, and ideal expectations and were linked to information, communication, daily care, and disease recognition. Half (11 of 22) of the expectations were ranked as very high (median score > 70), the 2 most important being good coordination between general practitioners and specialists (median score: 89, IQR: 71-96) and information on treatment adverse events (89, IQR: 71-96). Women had overall higher levels of expectations than did men. Expectations were not associated with psychosocial measures, except those related to disease recognition, and most of them were highly associated with increased concerns on disease constraints and uncertainty.

CONCLUSIONS

Patients have high expectations for information and communication among caregivers, the levels varying by gender and region. Patients also appear to request more active participation in their disease management.

Optimising the Inflammatory Bowel Disease Unit to Improve Quality of Care: Expert Recommendations

INTRODUCTION

The best care setting for patients with inflammatory bowel disease [IBD] may be in a dedicated unit. Whereas not all gastroenterology units have the same resources to develop dedicated IBD facilities and services, there are steps that can be taken by any unit to optimise patients' access to interdisciplinary expert care. A series of pragmatic recommendations relating to IBD unit optimisation have been developed through discussion among a large panel of international experts.

METHODS

Suggested recommendations were extracted through systematic search of published evidence and structured requests for expert opinion. Physicians [n = 238] identified as IBD specialists by publications or clinical focus on IBD were invited for discussion and recommendation modification [Barcelona, Spain; 2014]. Final recommendations were voted on by the group. Participants also completed an online survey to evaluate their own experience related to IBD units.

RESULTS

A total of 60% of attendees completed the survey, with 15% self-classifying their centre as a dedicated IBD unit. Only half of respondents indicated that they had a defined IBD treatment algorithm in place. Key recommendations included the need to develop a multidisciplinary team covering specifically-defined specialist expertise in IBD, to instil processes that facilitate cross-functional communication and to invest in shared care models of IBD management.

CONCLUSIONS

Optimising the setup of IBD units will require progressive leadership and willingness to challenge the status quo in order to provide better quality of care for our patients. IBD units are an important step towards harmonising care for IBD across Europe and for establishing standards for disease management programmes.

Bowel disorders and its spatial trend in Manitoba, Canada

BACKGROUND

Bowel disorders have destructive impacts on the patients social and mental aspects of life and can cause emotional distress. The risk of developing bowel incontinence also increases with age. The rate of incidence of inflammatory bowel disease in Manitoba, Canada, has been unusually raised. Therefore, it is important to identify trends in the incidence of bowel disorders that may suggest further epidemiological studies to identify risk factors and identify any changes in important factors.

METHODS

An important part of spatial epidemiology is cluster detection as it has the potential to identify possible risk factors associated with disease, which in turn may lead to further investigations into the nature of diseases. To test for potential disease clusters many methods have been proposed. The focused detection methods including the circular spatial scan statistic (CSS), flexible spatial scan statistic (FSS), and Bayesian disease mapping (BYM) are among the most popular disease detection procedures. A frequentist approach based on maximum likelihood estimation (MLE) has been recently used to identify potential focused clusters as well. The aforementioned approaches are studied by analyzing a dataset of bowel disorders in the province of Manitoba, Canada, from 2001 to 2010.

RESULTS

The CSS method identified less regions than the FSS method in the south part of the province as potential clusters. The same regions were identified by the BYM and MLE methods as being potential clusters of bowel disorders with a slightly different order of significance. Most of these regions were also detected by the CSS or FSS methods.

CONCLUSIONS

Overall, we recommend using the methods BYM and MLE for cluster detection with the similar population and structure of regions as in Manitoba. The potential clusters of bowel disorders are generally located in the southern part of the province including the eastern part of the city of Winnipeg. These results may represent real increases in bowel disorders or they may be an indication of other covariates that were not adjusted for in the model used here. Further investigation is needed to examine these findings, and also to explore the cause of these increases.