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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
  1. Vinh-An Huu Phan1,
  2. Daniel R van Langenberg1,2,
  3. Rachel Grafton1,
  4. Jane M Andrews1,3
  1. 1IBD Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
  2. 2Box Hill Hospital, Melbourne, Victoria, Australia
  3. 3School of Medicine, University of Adelaide & Department of Medicine, Adelaide, Australia
  1. Correspondence to Dr Jane M Andrews, Royal Adelaide Hospital, IBD Service, Department of Gastroenterology and Hepatology, Adelaide, South Australia, Australia; Jane.Andrews{at}health.sa.gov.au

Abstract

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.

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Footnotes

  • 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.

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