Interdisciplinary, prompt access IBD clinic: The hamilton health science experience

Abstract

Despite advances in medical management of IBD, patients suffering from IBD follow courses of relapses and remission. Many patients face multiple problems including medical and surgical issues arising from their IBD, as well as nutritional, social, psychiatric, bone health and pain management issues. These require additional information about medical therapy to optimize medication adherence, nutritional counseling, assistance with long term coping strategies, and support with psychosocial issues. This is best achieved though an interdisciplinary approach in order to deliver holistic comprehensive care. We characterized our institution's experience with a novel multidisciplinary IBD clinic Interdisciplinary team members consisted of four gastroenterologists (GI), one colorectal surgeon, two psychiatrists, one nurse practitioner (NP) and a registered dietician. One half day clinic with a GI and an NP was dedicated to complex IBD patients requiring for urgent access and possible changes in medical management. An interdisciplinary clinic for surgical, psychiatric and nutrition consultation was available once per month. Patients requiring urgent access were provided with a contact number during disease relapse; the urgency of access was determined during a telephone screening conducted by the NP who coordinated appropriate laboratory investigations and the next available appointment. Patients were informed that the appointment would be made to see one of the four GI's. Pre and Post patient satisfaction with the clinic score were also collected. 178 patient appointments were scheduled in 33 half-day clinic over period of 10 months. 28% of appointments were for review of recent IBD exacerbation; 20% for psychiatric counseling; 15% for discussion of change in medical management; 17% for nutritional counseling; 8% were urgent follow-up after recent hospitalization as result IBD exacerbation; 3% were pregnancyrelated issues of poor weight gain and change in treatment and the remaining visits were for surgical opinion for multiple complex fistulae and failed medical therapy. Nutritional assessment was conducted for gluten sensitivity, short bowel syndrome, low residue diet, weight gain and weight loss counseling, anemia and constipation. The majority of patients seen for psychiatric counseling had major depressive disorder with generalized anxiety disorder, adjustment and coping disorder, social anxiety, social isolation, one patient with suicidal ideations and one patient with dementia secondary to general medical condition. There was no difference in the pre and post patient satisfaction score; with the pre-scores of 4.72 (0.77) - Mean (SD) and the post score of 4.72 (0.58) - Mean (SD), on scale of 1-5. No Caption available. Management of IBD patients can be complex and diverse, based on each individual's needs during the course of the disease. We intended to assess patient satisfaction with this novel approach, compared to the traditional physician centered clinic model. Patients are accepting a shift from limited access to a primary GI to a team approach which includes a NP. Having prompt access during relapse and an interdisciplinary team approach with non-GI health care providers, working in collaboration with the patient, may improve patient outcomes. (Supported, in part, by an unrestricted grant from the Hamilton Academic Health Sciences Organization)