Adherence to Preventative Health Care Measures in Inflammatory Bowel Disease Patients Is Low

Abstract

Introduction: Prior studies have shown that preventative health issues are neglected in patients with inflammatory bowel disease. In 2017, the American College of Gastroenterology (ACG) published comprehensive 14-point guidelines regarding preventive care measures (PCMs) in IBD. The adherence to these guidelines has not been assessed. We aimed to evaluate adherence to PCMs outlined by ACG in IBD patients at our center. Methods: We conducted retrospective quality improvement study including IBD patients who had received care at our gastroenterology outpatient clinics between September, 2017 to October, 2017. Baseline patient characteristics and data regarding adherence to preventative health care measures was noted. Results: A total of 94 patients were included. Mean age was 47.6 years and 34% were males. 49% of the patients had Crohn's disease (CD), while 51% had ulcerative colitis. 58.5% of the patients were on long-term steroids, while 45.7% and 44.6% of the patients were on immunomodulators and biologics respectively. Majority of the patients (88%) had a PCP, and 56.6% of the female patients were established with a gynecologist. Adherence with appropriate PCMs as indicated was: Influenza 58.5%, pneumococcal: 56.3%, herpes zoster 19.5%, varicella zoster 11.6%, meningococcal 100%, Tetanus, Diphtheria and Pertussis (Tdap) 55.3%, HAV: 58.5%, HBV 80.5%, HPV 80%, depression screening: 55.3%, melanoma screening: 30.8%. In women on immunosuppressive therapy, 51.6% underwent annual cervical cancer screening, and 33.3% of patients on immunomodulators had non-melanoma skin cancer screening. Bone mineral density testing was performed 67.2% of patients in whom it was indicated, and smoking cessation was advised to 76.9% of CD patients who used tobacco. Conclusion: Despite comprehensive guidelines, PCMs in IBD patients continue to be neglected. There continues to be debate whether preventative care in IBD is best addressed by PCP or gastroenterologists. Although our sample size is small, our results demonstrate significant room for improvement. There is a trend towards better preventive care in patients with IBD who have a PCP in addition to a gastroenterologist. Our next steps include: feedback to our physicians regarding adherence to PCMs, development of electronic health record reminders, and placing flyers in patient rooms. We plan to collect post-intervention data to assess if our interventions lead to improvement in preventive health care delivery to IBD patients.619_A Figure 1. Adherence to preventive care measures in patients with IBD619_B Figure 2. Comparison between gastroenterology fellow and faculty in regards to adherence to preventive care measures in IBD