Guideline adherence and patient satisfaction in the treatment of inflammatory bowel disorders – an evaluation study

Abstract

BackgroundCrohn's disease (CD) and ulcerative colitis (UC) are the most frequent inflammatory bowel disorders (IBD). IBD cause a significant burden to society due to extensive health care utilization from the first clinical symptoms until diagnosis and thereafter due to direct and indirect costs. Besides the socio-economic impact of CD and UC, gastrointestinal and extraintestinal symptoms affect quality of life, but there is remarkably little data about the quality of treatment as assessed by patient satisfaction, quality of life and adherence to guidelines. Thus the aim of this study was to identify variables that influence quality of treatment and quality of life as well as patient satisfaction.MethodsThe Essener Zirkel Study was a cross sectional study of 86 IBD-patients with a confirmed diagnosis of CD or UC. They were recruited at primary, secondary and tertiary care settings. Quality of treatment, quality of life and patient satisfaction were evaluated. Consulting behaviour and number of examinations, duration of disease and variables regarding adherence to guidelines were evaluated, too.Results59 (69%) patients had CD and 27 had UC (31%). 19% spent more than four years until the suspected diagnosis of IBD was confirmed and visited more than five physicians. All patients showed a significantly reduced quality of life compared to the 1998 German normative population. In spite of being under medical treatment, nearly half of the patients suffered from strong quality of life restricting symptoms. Over all, 35% described their treatment as moderate or bad. Patients who consulted psychotherapists and non-medical practitioners suffered significantly less from depression.ConclusionBesides structural deficiencies due to the health care policy, we revealed the adherence to guidelines to be a problem area. Our findings support the assumption, that providing better health care and especially maintaining constant patient-physician communication improves patient satisfaction.

Prodromal Irritable Bowel Syndrome May Be Responsible for Delays in Diagnosis in Patients Presenting with Unrecognized Crohn’s Disease and Celiac Disease, but Not Ulcerative Colitis

“…In IBD prodromes of between 4 and 4.5 years have been reported: n = 66, median 7.7 years ± 10.7 years in Crohn's disease; median 1.2 ± 1.8 years in ulcerative colitis [3]; n = 86 of which 19% had a mean prodrome of 4 years or greater [4]. Furthermore, prodromes of 11-year duration were recently reported in The Manitoba IBD Cohort Study (n = 112, mean duration 11 years, ranging from 3 to 48 years) [5].…”

Addressing current treatment challenges in Crohn's disease in real life: A physician's survey

“…The few studies having looked at adherence to guidelines among gastroenterologists have revealed equivocal results 30,31 . However, the treatment of CD appeared to be appropriate in most patients according to cohort studies from Switzerland and Europe 32,33 .…”

Assessing patients’ satisfaction with anti-TNFα treatment in Crohn’s disease: qualitative steps of the development of a new questionnaire

“…Some studies assessed patients’ perceptions on benefits and risks of anti-TNF treatments,31,32 but to our knowledge, satisfaction with treatment has been poorly reported in the literature 10. The SPACE © questionnaire is thus the first tool to assess patient satisfaction with anti-TNFα treatment in CD.…”

“…Quality-of-life studies were performed in inflammatory bowel diseases,8,14–17 in clinical trials, HRQL was used as a secondary endpoint 12. However, no study has assessed patients’ satisfaction in CD 10. A recent prospective study showed that despite the preference of CD patients for adalimumab versus infliximab for maintenance, a proportion of patients returned to infliximab due to intolerance, supporting the importance of patients’ outcomes in patients’ behavior towards CD’s therapeutics and their efficacy 18…”