A dedicated inflammatory bowel disease service quantitatively and qualitatively improves outcomes in less than 18 months: a prospective cohort study in a large metropolitan centre
- 1IBD Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
- 2Box Hill Hospital, Melbourne, Victoria, Australia
- 3School of Medicine, University of Adelaide & Department of Medicine, Adelaide, Australia
- Correspondence to Dr Jane M Andrews, Royal Adelaide Hospital, IBD Service, Department of Gastroenterology and Hepatology, Adelaide, South Australia, Australia;
Contributors Data collection: V-AP, RG. Data/statistical analysis: DRvL, JMA. Drafting of paper: V-AP, JMA, DRvL. Guarantor: JMA, V-AP.
- Received 8 November 2011
- Accepted 8 March 2012
- Published Online First 1 May 2012
Introduction Maintaining high efficacy and quality of care in inflammatory bowel disease (IBD) management is a priority. The authors examined whether the introduction of a formal IBD Service (IBDS) positively influenced outcomes for their patients.
Methods In 2007-2008, all IBD patients attending the Royal Adelaide Hospital were surveyed regarding clinical/demographic data, IBD knowledge, quality of life, mental health and satisfaction. Survey responders were re-surveyed ≥15 months later.
Results 162 responded to survey 1 and 81 again responded to survey 2. Within the responders, 61% had Crohn's disease and 48% were men. Compared with survey 1, the proportions of patients with improved knowledge, adherence, satisfaction with care, QoL (≥5 points), anxiety and depression scores were 63% (95% CI 51 to 73), 62% (95% CI 50 to 72), 65% (95% CI 54 to 76), 42% (95% CI 31 to 54), 52% (95% CI 40 to 63) and 43% (95% CI 32 to 55), respectively. When comparing survey 2 with survey 1, reductions in hospitalisation (48% vs 30%, p=0.02), courses of corticosteroids and opiates (mean 1.63 vs 0.91 and 1.00 vs 0.61, both p<0.05) and overall medications (5.63 vs 4.65, p<0.05), were seen. Fewer 2009 non-responders required hospitalisation (53% vs 21%, p<0.001), suggesting a `cohort' rather than `responder-specific' effect.
Conclusions The introduction of an IBDS resulted in improved patient outcomes with significant reductions in negative markers for IBD morbidity including: hospitalisations, polypharmacy, steroid and opiate use. Despite increased costs in additional staff, these measures are likely to be cost effective.
Competing interests None.
Ethics approval This study was approved by the Research Ethics Committee of the Royal Adelaide Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.