Optimizing Adult Ambulatory Care in Inflammatory Bowel Disease

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 diseaseâ€, “organizational modelsâ€, “patient care teamâ€, “quality improvementâ€, and “physician assistantsâ€.
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.