Interventions to Improve Adherence to Preventive Care in Inflammatory Bowel Disease: A Systematic Review

Abstract

Background Preventive health measures reduce treatment and disease-related complications including infections, osteoporosis, and malignancies in patients with inflammatory bowel disease (IBD). Although guidelines and quality measures for IBD care highlight the importance of preventive care, their uptake remains variable. This systematic review evaluates interventions aimed at improving the rates of provision and uptake of preventive health measures, including vaccinations, bone density assessment, skin cancer screening, cervical cancer screening, and smoking cessation counseling. Methods We searched PubMed, MEDLINE, EMBASE, and CENTRAL for full text articles published until March 2021. Studies were included if they evaluated interventions to improve the provision or uptake of 1 or more preventive health measures in adult IBD patients and if they reported pre- and postintervention outcomes. Results In all, 4655 studies were screened, and a total of 17 studies were included, including 1 randomized controlled trial, 1 cluster-controlled trial, and 15 prospective interventional studies. A variety of interventions were effective in improving the rates of adherence to preventive health measures. The most common interventions targeted gastroenterologists, including education, electronic medical records tools, and audit feedback. Other interventions targeted patients, such as education, questionnaires, and offering vaccine administration at clinic visits. Few interventions involved IBD nurses or primary care physicians. Conclusions A range of interventions—targeted at gastroenterologists, patients, or both—were effective in improving the provision and uptake of preventive care. Future studies should involve randomized controlled trials evaluating multifaceted interventions that target barriers to adherence and involve IBD nurses and primary care physicians.

Adherence to Vaccines in Adult Patients with Immune-Mediated Inflammatory Diseases: A Two-Year Prospective Portuguese Cohort Study

“…To the best of our knowledge, studies on the prescription and adherence rates to various vaccines among patients with IMIDs, including those with cancer, have not been reported so far. The available studies include data about vaccine uptake but not about its prescription [ 12 , 13 ]. In this sense, it has not been possible to estimate adherence since non-administered vaccines may be related to a lack of prescription or to a lack of adherence.…”

Using American College of Gastroenterology Guidelines to provide effective health maintenance for patients with inflammatory bowel disease

“…A review of multiple publications on interventions to improve adherence to health maintenance for patients with IBD found success with patient questionnaires and order sets for gastroenterologists (Yu et al, 2021), but most of these studies spanned over 1 year. The brevity of this project likely affected order completion rates.…”

Improving Adherence to Preventive Care Among Adolescents With Inflammatory Bowel Disease

“…Our recent systematic review demonstrated that a range of interventions are effective in improving the rates of provision and uptake of preventive health measures among IBD patients (4). Among these, we believe interventions that coordinate care between gastroenterologists and PCPs are particularly valuable, given the conflicting perceptions among gastroenterologists and PCPs about who should assume responsibility for providing preventive care (5).…”

“…For example, implementation of a health maintenance screening proforma that the gastroenterologist completes, with specific instructions for the PCP to carry out the required preventive health measures for the patient. Additionally, IBD nurse-led interventions, education, questionnaires, audit feedback, EMR templates, and clinical decision support tools are also effective strategies to improve adherence to preventive care (4).…”