P021 The potential impact of provider gender on IBD management

Abstract

BACKGROUND: Health maintenance guidelines have been published to ensure optimal clinical outcomes for individuals with inflammatory bowel disease (IBD), with recommendations including the evaluation of bone density, eye, and skin health. However, it has been suggested that there is variability in adherence to health maintenance recommendations. This study evaluated both the gender of providers discussing health maintenance with patients, and the overall rate of physicians' recommendations for Dual-energy X-ray absorptiometry (DXA) scans, vitamin D levels, ophthalmologic exams, and skin protective measures at an urban university medical center. METHODS: A retrospective chart review was performed evaluating all IBD patients seen at a university gastroenterology clinic over a 5-year period was performed. Patients' IBD diagnosis, recommendations for DXA, vitamin D levels, ophthalmologic exams, and skin protective measures (sunscreen and/or dermatology referral) were obtained. Patient and physician gender were recorded. A database was generated using Microsoft Excel. Statistical analysis was performed using Fisher's Exact Test with significance set at P < 0.05. The study was approved by the IRB. RESULTS: 393 IBD patients were identified (175 males, 218 females) with mean age of 44.4 (age range: 20–82). 279 (71.0%) had Ulcerative Colitis (UC), 96 (24.4%) had Crohn's disease (CD), 7 (1.8%) with unspecified colitis, and 11 (2.8%) had microscopic colitis. Of the 393 patients, 279 (71.0%) were seen by male providers and 114 (29.0%) were seen by female providers. 249 (63.4%) patients had vitamin D and 110 (28%) had DXA scans performed. Ophthalmologic referrals were offered to 125 (27.8%). 83 (21.1%) were counseled about skin protective measures and given dermatology referrals. Significantly more female providers recommended vitamin D (P = 0.015), DXA screening (P = 0.027), ophthalmologic evaluations (P < 0.0001) and dermatologic referrals (P < 0.0001) compared to male providers. There was no significant difference of the performance of health maintenance recommendations based upon disease type. CONCLUSION(S): This study revealed that there was inconsistent adherence to IBD health maintenance recommendations. While female physicians more frequently recommended vitamin D screening, DXA scans, ophthalmologic examinations, and skin evaluations, there was a clear need to improve screening by all physicians. While this study was limited based upon retrospective design, small sample size, and single institution cohort, it provides a foundation for future research that addresses IBD management. Increased efforts to optimize IBD care will improve overall clinical outcomes.