Improving quality of care in inflammatory bowel disease: What changes can be made today?

Panés, Julián; O’Connor, Marian; Peyrin–Biroulet, Laurent; Irving, Peter M; Petersson, Joel; Colombel, Jean–Frédéric

doi:10.1016/j.crohns.2014.02.022

Cited by 73 publications

(67 citation statements)

References 37 publications

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“…With increased attention paid to variability in the type and cost of care delivered to patients, several gastroenterology societies are developing measures to assess quality of care. Systematic eff orts should be developed to incorporate quality measures of care in practice ( 27,28 ). Several of the recommendations discussed in this article are included or suggested as quality measures by national or international gastroenterology societies.…”

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confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

View full text Add to dashboard Cite

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“…26 This study shows that the shortened CDWDQ is a valid and reliable tool which will help clinicians to detect, measure, and monitor work disability in patients with the condition. 14 Most questionnaires on disability or quality of life are time-consuming for both patients and physicians.…”

Section: Discussionmentioning

confidence: 97%

Development and Validation of the Short Crohnʼs Disease Work Disability Questionnaire

Vergara

Sicilia

Prieto

et al. 2016

Inflammatory Bowel Diseases

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“…Second, the inclusion of IBD patients or primary care physicians into the survey may have provided a useful viewpoint in terms of how best to represent their opinions to ensure that the MDT remains patient centred. Lastly, MDT-driven care is arising throughout a number of European IBD centres 14. Representation from IBD specialists from these centres may have provided useful international perspective.…”

Section: Discussionmentioning

confidence: 99%

“…MDT-driven care is now being introduced into inflammatory bowel disease (IBD) centres 14. European centres have demonstrated variability in MDT-driven care 15.…”

Section: Introductionmentioning

confidence: 99%

Establishing the aims, format and function for multidisciplinary team-driven care within an inflammatory bowel disease service: a multicentre qualitative specialist-based consensus study

Morar

Sevdalis

Warusavitarne

et al. 2017

Frontline Gastroenterol

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Objective To obtain a specialist-based consensus on the aims, format and function for MDT-driven care within an inflammatory bowel disease (IBD) service. Design This was a prospective, multicentre study using a Delphi formal consensus-building methodology. Setting Participants were recruited nationally across 13 centres from July to August 2014. Participants 24 participants were included into the Delphi Specialist Consensus Panel. They included six consultant colorectal surgeons, six gastroenterologists, five consultant radiologists, three consultant histopathologists and 4 IBD nurse specialists. Interventions Panellists ranked items on a Likert scale (1=not important to 5=very important). Items with a median score >3 were considered eligible for inclusion. Main outcome measures Consensus was defined with an IQR ≤1. Consensus on categorical responses was defined by an agreement of >60%. Results A consensus on items (median; IQR) that described the aims of the MDT-driven care that were considered very important included: advance patient care (5;5-5), provide multidisciplinary input for the patient's care plan (5;5-5), provide shared experience and expertise (5;5-5), improve patient outcome (5;5-5), deliver the best possible care for the patient (5;5-5) and to obtain consensus on management for a patient with IBD (5;4-5). A consensus for being a core MDT member was demonstrated for colorectal surgeons (24/24), radiologists (24/24), gastroenterologists (24/24), nurse specialists (24/24), dieticians (14/23), histopathologists (21/23) and coordinators (21/24). Conclusions This study has provided a consensus for proposed aims, overall design, format and function MDT-driven care within an IBD service. This can provide a focus for core members, and aid a contractual recognition to ensure attendance and proactive contribution.

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Improving quality of care in inflammatory bowel disease: What changes can be made today?

Cited by 73 publications

References 37 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Development and Validation of the Short Crohnʼs Disease Work Disability Questionnaire

Establishing the aims, format and function for multidisciplinary team-driven care within an inflammatory bowel disease service: a multicentre qualitative specialist-based consensus study

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