P065 INTERNISTS’ PRACTICE AND PERCEPTIONS OF RESPONSIBILITY OF IBD-RELATED HEALTH MAINTENANCE

Abstract

Health maintenance (HM) of patients with IBD is multifactorial and of well-established importance. However, the extent that it is practiced and whether the gastroenterologist (GI) or primary care provider (PP) would or should assume its responsibility are not clear. We anonymously surveyed a convenient sample of 94 internists who are affiliates or trainees of St. Louis University (SLU), St. Louis, MO (11.6% university faculty, 5.9% VA faculty, 82.5% medical residents), using electronic or paper self-administered instruments. Out of 87 respondents (response rate 92.5%), 47% stated that PP should manage IBD-related HM issues in general (vs. 52% stating that the GI should). However, only 9% reported that they assess these issues all the time (34% most of the time). Further, only 21% reported always assessing patients for depression and anxiety, 1% enrolling patients in skin protection/dermatological surveillance programs, 0% & 3% screening for melanoma and non-melanoma skin cancer in patients on immune-modulators,18% prescribing Ca & vit D to patients on corticosteroids, 16% screening for osteoporosis, 29% screening patients on anti-TNF therapy for tuberculosis, 11% performing nutritional assessment, & 33% checking appropriate laboratory investigations in patients treated with immune-modulators. On the other hand, 62% always assessed the need for surveillance colonoscopies and 70% counseled for smoking cessation. The data indicates a sharp divide in SLU internists’ perception of who should take responsibility of IBD-related HM issues and that these issues, except for surveillance colonoscopy and smoking cessation, are mostly not addressed by internists. The applicability of our results to internists in other settings is not known. We suggest that GIs maintain full responsibility for IBD-related HM issues. Alternatively, specific strategies, such as more explicit guidelines for internists and electronic medical record reminders and checkpoints would be required.