Optimizing Adult Ambulatory Care in Inflammatory Bowel Disease

Roberta Schoenfeld

Abstract


Intro: Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic, complex and unpredictable disease affecting an increasing number of patients from a young age, worldwide. The purpose of this article is to review the literature on outpatient care models used to treat adults with IBD, and to gain insight on how to improve quality of care and reduce costs.
Method:  A comprehensive review of recent literature on PubMed, Scopus, and Google Scholar databases about care models used to treat IBD was performed. Key terms included “inflammatory bowel disease”, “organizational models”, “patient care team”, “quality improvement”, and “physician assistants”.
Results: Studies showed that an integrated care model decreases hospital admissions, IBD-related surgeries, and comorbidities of IBD, ultimately decreasing direct and indirect costs of IBD compared to a more traditional patient-physician model.  A gastroenterologist-led multidisciplinary team (MDT), involving comprehensive care by IBD nurses, a surgeon, psychologist, dietician, pharmacist, and other members as needed is recommended. No research was found on the use of physician assistant (PAs) in IBD care.
Conclusions: A holistic approach to IBD care delivered by a MDT with structured monitoring, active follow-up, patient education, and prompt access to care improves outcomes for IBD patients. More research is needed on the cost-effectiveness of integrated care models to demonstrate long-term value and secure funding for implementation. Future research should examine how the use of PAs in IBD care influences patient outcomes, healthcare costs, as well as patient and physician satisfaction.


Keywords


Physician Assistant, PA, Canadian physician assistant, IBD, Crohn's

Full Text:

PDF

References


References

Best Practices in IBD Care [Internet]. Canadian Digestive Health Foundation. 2013 [cited 2018 Apr 1]. p. 1–36. Available from: http://www.cdhf.ca/bank/document_en/75best-practices-in-ibd-care.pdf

Mikocka-walus A, Andrews JM, Rampton D, Goodhand J, Woude J Van Der, Bernstein CN. How can we improve models of care in inflammatory bowel disease? An international survey of IBD health professionals. J Crohn’s Colitis [Internet]. 2014;8(12):1668–74. Available from: http://dx.doi.org/10.1016/j.crohns.2014.07.009

Standards for the Healthcare of People who have Inflammatory Bowel Disease [Internet]. Crohn’s and Colitis UK. The IBD Standards Group; 2013 [cited 2018 Apr 1]. p. 1–32. Available from: https://www.crohnsandcolitis.org.uk/improving-care-services/health-services/ibd-standards

Miller H, Farraye F. Inflammatory Bowel Disease. In: Griggs R, Wing E, Fitz G, editors. Cecil Essentials of Medicine. 9th ed. Philadelphia, PA: Elsevier Inc.; 2016. p. 417–24.

Mikocka-Walus AA, Andrews JM, Bernstein CN, Graff LA, Walker JR, Spinelli A, et al. Integrated models of care in managing inflammatory bowel disease: A discussion. Inflamm Bowel Dis. 2012;18(8):1582–7.

Sack C, Phan VA, Grafton R, Holtmann G. A chronic care model significantly decreases costs and healthcare utilisation in patients with inflammatory bowel disease. J Crohn’s Colitis [Internet]. 2011;6(3):302–10. Available from: http://dx.doi.org/10.1016/j.crohns.2011.08.019

Peña-Sánchez JN, Lix LM, Teare GF, Li W, Fowler SA, Jones JL. Impact of an integrated model of care on outcomes of patients with inflammatory Bowel diseases: Evidence from a population-based study. J Crohn’s Colitis. 2017;11(12):1471–9.

Druss B, Rohrbaugh R, Levinson C, Rosenheck R. Integrates medical care for patients with serious psychiatric illness: A randomized trial. Arch Gen Psychiatry. 2001;58:861–8.

Ho S, Brau N, Cheung R, Liu L, Sanchez C, Sklar M, et al. Integrated care increases treatment and improves outocme of patients with chronic hepatitis C virus infection and psychiatirc illness or substance abuse. Clin Gastroenterol Hepatol. 2015;13:2005–20014.

Panés J, Connor MO, Peyrin-biroulet L, Irving P, Petersson J, Colombel J. Improving quality of care in inflammatory bowel disease: What changes can be made today? J Crohn’s Colitis [Internet]. 2014;8(9):919–26. Available from: http://dx.doi.org/10.1016/j.crohns.2014.02.022

Louis E, Dotan I, Ghosh S, Mlynarsky L, Reenaers C. Optimising the inflammatory bowel disease unit to improve quality of care: Expert recommendations. J Crohn’s Colitis. 2015;685–91.

Negreanu L, Bataga S, Prelipcean CC, Dobru D, Diculescu M, Dumitru E, et al. Excellence centers in inflammatory bowel disease in Romania: A measure of the quality of care. J Gastrointest Liver Dis. 2014;23(3):333–7.

Shitrit A, Cohen Y, Hassin O, Ya’acov A, Farkash R, Koslowsky B, et al. Antenatal management for women with inflammatory bowel disease: Experience from our “IBD MOM” clinic. Dig Disord Sci. 2018;

Berstein C, Zhang L, Graff L, Walker J, Fisk J, Patten S, et al. The validity and reliability of screening measures for depression and anxiety disorders in inflammatory bowel disease. Inflamm Bowel Dis. 2018;

Bitton A, Vutcovici M, Lytvyak E. Selection of quality indicators in IBD: Integrating physician and patient perspectives. Inflamm Bowel Dis.

Haskey, Natasha; Pena-Sanchez, Juan Nicolas; Jones, Jennifer L and Fowler SA. Development of a screening tool to detect nutrition risk in patients with inflammatory bowel disease. Asia Pac J Clin Nutr. 2018;27(4):756–62.

Greene L, Sapir T, Moreo K, Carter JD, Patel B, Higgins PDR. Impact of quality improvement educational interventions on documented adherence to quality measures for adults with Crohn’s disease. Inflamm Bowel Dis. 2015;21(9):2165–71.

Regueiro MD, McAnallen SE, Greer JB, Perkins SE, Ramalingam S, Szigethy E. The inflammatory bowel disease specialty medical home: A new model of patient-centered care. Inflamm Bowel Dis. 2016;22(8):1971–80.

Kosinski LR, Brill J, Regueiro M. Making a medical home for IBD patients. Curr Gastroenterol Rep. 2017;19(5):1–7.

Berry SK, Siegel CA, Melmed GY. Quality improvement initiatives in inflammatory bowel disease. Curr Gastroenterol Rep. 2017;19(41):17–21.

St Mark’s Hospital Foundation [Internet]. St Mark’s Hospital and Academic Institute. 2017 [cited 2018 Apr 1]. Available from: http://www.stmarkshospital.nhs.uk/about/st-marks-hospital-foundation/

New Crohn’s and Colitis Canada Network Unites World-Class Canadian Healthcare Centres [Internet]. Crohn’s and Colitis Canada. 2016 [cited 2018 Apr 1]. Available from: http://crohnsandcolitis.ca/Research/Our-funded-research/PACE-Network

Deen WK Van, Spiro A, Ozbay AB, Skup M, Centeno A, Duran NE. The impact of value-based healthcare for in fl ammatory bowel diseases on healthcare utilization: A pilot study. Eur J Gastroenterol Hepatol. 2017;29(3):331–7.

2015 Statistical Profile of Certified Physician Assistants by Specialty [Internet]. National Commission on the Certification of Physician Assistants. 2017. p. 1–127. Available from: http://www.nccpa.net/Uploads/docs/2015StatisticalProfilebySpecialty.pdf

Dorn SD. Mid-level providers in gastroenterology. Am J Gastroenterol [Internet]. 2010;105(2):246–51. Available from: http://dx.doi.org/10.1038/ajg.2009.275

What is a Physician Assistant? [Internet]. University of Manitoba. 2017 [cited 2018 May 1]. Available from: http://umanitoba.ca/faculties/health_sciences/medicine/education/paep/whatisapa.html

Role of PAs in the Health System [Internet]. Canadian Association of Physician Assistants. 2018 [cited 2018 Apr 1]. Available from: https://capa-acam.ca/about-pas/pa-fact-sheet/

Guagnozzi D, Lucendo AJ, Guagnozzi D, Lucendo AJ. Anemia in inflammatory bowel disease: A neglected issue with relevant effects. World J Gastroenterol. 2014;20(13):3542–51.


Refbacks

  • There are currently no refbacks.


Copyright (c) 2019 Roberta Schoenfeld

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

http://jcanpa.ca