Quality of care in Crohn's disease

Inflammatory bowel disease associated knowledge in South Indian populations: rational Study

Background

Objectives

The pivotal of the study was to compare the effectiveness of education in disease-associated knowledge of Inflammatory Bowel Disease (IBD) patients between pre-test and post-test using the IBD-KNOW questionnaire and patient educational resources.

Methods

This study used a patient proforma and IBD- KNOW questionnaire to perform the study prospectively by interviewing method. The patient selection was based on inclusion and exclusion criteria by convenient sampling technique from November 2018 to July 2019 at a multispecialty hospital. Knowledge scores and inter-item correlation were calculated between the pre-test and post-test by R Programming software with p<0.05.

Results

Among 40 patients with IBD diagnosis, the baseline sociodemographic characteristics were recorded. The response rate of IBD knowledge between the pre-test and post-test resulted in significant differences with varying scales but the response rate was lesser in the domains of management and pregnancy-based questions in the pre-test and post-test.

Conclusions

Recently there was a swift in IBD incidence, this may be improved by affording suitable patient education and counseling for further knowledge level in managing the disease by coping strategy. On comparison between the pre-test and post-test, this study recommends innovative educational methods to enable continuing education for chronic disease which can be easily accessible and reliable for IBD patients.

Quality of care indicators in inflammatory bowel disease in a tertiary referral center with open access and objective assessment policies

BACKGROUND

In the management of inflammatory bowel diseases, there is considerable variation in quality of care.

AIMS

The aim of this study was to evaluate structural, access/process components and outcome quality indicators in our tertiary referral IBD center.

METHODS

In the first phase, structural/process components were assessed, followed by the second phase of formal evaluation of access and management on a set of consecutive IBD patients with and without active disease (248CD/125UC patients, median age 35/39 years).

RESULTS

Structural/process components of our IBD center met the international recommendations. At or around the time of diagnosis usual procedures were full colonoscopy in all patients, with ileocolonoscopy/gastroscopy/CT/MRI in 81.8/45.5/66.1/49.6% of CD patients. A total of 86.7% of CD patients had any follow-up imaging evaluation or endoscopy. The median waiting time for non-emergency endoscopy/CT/MRI was 16/14/22 days. During the observational period patients with flares (CD/UC:50.6/54.6%) were seen by specialist at the IBD clinic within a median of 1day with same day laboratory assessment, abdominal US, CT scan/surgical consult and change in therapy if needed. Surgery and hospitalization rates were 20.1/1.4% and 17.3/3.2% of CD/UC patients.

CONCLUSION

Our results highlight that structural components and processes applied in our center are in line with international recommendations, including an open clinic concept and fast track access to specialist consultation, endoscopy and imaging.

Patients' perceptions of quality of care and follow-up in inflammatory bowel disease

BACKGROUND AND AIMS

Quality of care (QoC) has gained increased attention in IBD. A better QoC has, historically, been linked to improved treatment outcomes. Even so, factors of equal importance to patients may be quality of life (QoL), patient-physician communication and access to care. Recent surveys suggest that IBD care in Europe is suboptimal.

METHODS

Patients were recruited from nine hospitals in the south-eastern and western part of Norway as a part of an observational, multicenter study In addition to clinical and socio-demographic factors; a purposely designed 26 item questionnaire was used to quantify aspects related to IBD care, including QoC. Moreover, the Fatigue Questionnaire (FQ) was used to investigate fatigue.

RESULTS

In total, 411 patients were included. Of these, 231 were diagnosed with CD and 180 with UC. Furthermore, 86.1% (354/411) were satisfied with the quality of IBD follow-up and only 4.1% (17/411) were dissatisfied. Most dissatisfaction was related to: lack of focus on personal relations (18.2%), HRQoL (15.1%), general practitioner knowledge of IBD (13.9%), ability to talk about important topics (7.8%), and hospital discharge communication (9.4%). Higher age and longer disease duration was associated with improved QoC scores in both UC and CD. Fatigue was associated with decreased QoC scores in both diagnoses.

CONCLUSIONS

Patients are satisfied with quality of care in IBD. However, communication seems to be an important area of improvement - not only related to patient-physician communication, but also to transitional communication between different health-care levels.

Paediatric Crohn Disease: Disease Activity and Growth in the BELCRO Cohort After 3 Years Follow-up

OBJECTIVE

The Belgian registry for paediatric Crohn disease (BELCRO) cohort is a prospective, multicentre registry for newly diagnosed paediatric patients with Crohn disease (CD) (<18 years) recruited from 2008 to 2010 to identify predictive factors for disease activity and growth.

METHODS

Data from the BELCRO database were evaluated at diagnosis, 24 and 36 months follow-up.

RESULTS

At month 36 (M36), data were available on 84 of the 98 patients included at diagnosis. Disease activity evolved as follows: inactive 5% to 70%, mild 19% to 24%, and moderate to severe 76% to 6%. None of the variables such as age, sex, diagnostic delay, type of treatment, disease location, disease activity at diagnosis, and growth were associated with disease activity at M36. Paediatricians studied significantly less patients with active disease at M36 compared with adult physicians. Sixty percent of the patients had biologicals as part of their treatment at M36. Adult gastroenterologists initiated biologicals significantly earlier. They were the only factor determining biologicals' initiation, not disease location or disease severity at diagnosis. Median body mass index (BMI) z score evolved from -0.97 (range -5.5-2.1) to 0.11 (range -3.4-2) and median height z score from -0.15 (range -3.4-1.6) to 0.12 (range -2.3-2.3) at M36. None of the variables mentioned above influenced growth over time.

CONCLUSIONS

Present treatment strategies lead to good disease control in the BELCRO cohort after 3 years. Logistic regression analysis did not show any influence of disease location or present treatment strategy on disease activity and growth, but patients under paediatric care had significantly less severe disease at M36.