IBD Care Research Articles

Improving IBD self-management — integrating psychological strategies into IBD care

Gastrointestinal NursingVol. 10, No. 4 Conference ReportImproving IBD self-management — integrating psychological strategies into IBD careMelanie TempleMelanie TempleSearch for more papers by this authorMelanie TemplePublished Online:16 Aug 2013https://doi.org/10.12968/gasn.2012.10.4.27aAboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Temple MT (2008) The Bucket Model — A Pictorial Approach to Introducing Psychological and Life Balance Concepts into Physical Illness Care. Unpublished Google Scholar FiguresReferencesRelatedDetails 1 May 2012Volume 10Issue 4ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 16 August 2013 Published in print 1 May 2012 Information© MA Healthcare LimitedPDF download

N003 Development of a specialist nurse educational program: The NIICE (Nurses Initiative in IBD Care and Education) in Canada program

more PxE for IM (P< 0.001) and anti-TNF (p = 0.02) in patients with inactive disease. In 126 (45%), the PxE was for drugs to which the patient was naive. These were initiated independently in 96 (76%). Of these 11 (11%) were discussed for confirmation with a physician. Almost all new drugs were commenced in active disease, with only 9 in inactive disease (p < 0.001). A further 42% of all PxE were repeat prescriptions. Thirty seven (13%) of PxE were dose changes. Fifty of the 279 (18%) PxE involved physician consultation. Twenty-three of the 50 (8%) were for confirmation, significantly greater number had active disease (p = 0.003). A further 15 (5%) of drugs were commenced after a consensus decision at a clinical meeting. Conclusions: IBDNS independently prescribe the full range of IBD drugs, in different settings, with the majority of prescribing for active disease. This service provides rapid access, flexibility and allows IBDNS greater autonomy.

P339 An audit of IBD care: Are we up to standards? A patients perspective

P339 An audit of IBD care: Are we up to standards? A patients perspective

Audit shows IBD care going in the right direction in the UK

Audit shows IBD care going in the right direction in the UK

T1032 Broadening the Access to Specialized IBD Care Using a Consumer Grade Affordable Telemedicine System

Aim: An exploratory, qualitative study examining the attitudes of gastroenterologists, patients, and medical students regarding the use of patients' expressive writings about IBS in the outpatient setting. Methods: IBS patients (P), Gastroenterologists (GI) and Medical students (MS) from a single academic institution (BU) were asked to read three representative IBS expressive writings selected by the authors from a previous study. All participants were interviewed regarding the utility and feasibility of using the writings in an outpatient clinical setting. All responses were recorded verbatim and qualitatively analyzed by the authors. Results: 10/10 GI (8 attending, 2 fellows), 10/14 P and 10/13 MS agreed to participate. GI: age (mean ± SD) 39.2 ± 7.7, M 80 %, y of practicing 7 ± 12.4, average # of IBS patients/ week 8.5 ± 7.2: MS: age 24.6 ± 2.0, M 40%, y of med. school 1.7 ± 1.10; P: age 43.3 ± 15.2, M 30%, y with IBS 15 ± 16, number of visits for IBS / 12 months 2.7 ± 2.9. The length of the writings was a 1/2 typed page (range: 1/2 3/4 typed page), interview time 15.4 ± 5.5 minutes. The actual time needed to read one writing was (1.7 min ± 0.5) vs. perceived time (2.8 min ± 1.1). 9/10 patients expressed interest in writing in the future. Although 7/10 of GI reported not learning anything surprising from the writings, 9/10 GI were interested in using them in clinical practice. 10/10 P felt that home is the best setting for writing, while GI favored the waiting room over home in order to limit length of writing. MS first response to writing was more empathic than that of the GI. The main themes identified during the interviews are outlined in Table 1. Conclusion: Our results indicate that gastroenterologists, medical students, and patients are very receptive to using IBS expressive writing in the outpatient setting and find it a useful tool in obtaining clinical information as well as helpful in promoting empathic physician patient relationships. A follow-up trial will study the effects of using this modality in outpatient setting on IBS clinical outcomes. Further implications include the use of patients' writings for medical training. TABLE 1

IBD care in Europe: A comparative audit of the inpatient management of Crohn's disease and ulcerative colitis using the national UK IBD audit tool

Background and aims The National UK IBD audit tool is an electronic database created to improve the quality and safety of care for IBD patients by auditing individual patient care, service resources and organisation against national standards. We used the National UK IBD audit tool to compare the organisation and process of IBD care between services in Oxford (UK) and Milan (Italy), as a pilot study to evaluate its application outside national boundaries. Methods Clinical and demographic data of patients with CD and UC, consecutively admitted during a 2 month period, were collected and compared between the centres, to each other and to the UK IBD standards obtained by previous audit analyses performed in Oxford in 2006. Results 20 and 26 patients with UC were admitted in Oxford and Milan, as well as 21 and 20 patients with CD, respectively. Most admissions in Milan were planned admissions for moderately active treatment-refractory disease. No patient died. Oxford had a higher surgery rate. Endoscopy for UC consisted mainly of colonoscopy in Milan (92%) and flexible sigmoidoscopy in Oxford (64%). In CD, Oxford data revealed a higher use of immununomodulators and CT scan, compared with higher use of bowel ultrasound in Milan. CRP was the preferred biomarker of disease activity. The following areas did not reach the standards set for the 2006 UK IBD Audit: the lack in Milan of IBD specialist nurses and few dietitian visits, as well as little attention to heparin prophylaxis and abdominal radiography in UC. Both sites paid little attention to stool cultures and revealed a high rate of active smokers in CD and little attention to bone protection in steroids users. Since the 2006 audit in Oxford, improvements include IBD specialist nurse visits, dietitian visits, number of active smokers, stool samples, prophylactic heparin, bone protection and nutritional assessment. Conclusions Consistent procedural differences between Oxford and Milan identified by audits of both UC and CD could be resolved by organisational change, with an improvement in the service. The UK IBD audit tool is an easy instrument to assess the processes and outcomes of care delivery in IBD and can be applied also outside UK.

Improving quality of care in IBD: A STEEEP challenge

Improving quality of care in IBD: A STEEEP challenge

Stem cell treatment may offer Crohn′s cure

Stem cell treatment may offer Crohn′s cure; Study explores IBD rise in Scottish children; British Society of Gastroenterology calls for round-the-clock bleeding care in hospitals; Sound bites; Star gets vocal on IBD care; Survival rate high if bowel cancer is caught early; Ethnic origin influences views on methods of bowel cancer screening

Les scores endoscopiques des MICI

Endoscopy is the gold standard for IBD diagnosis and care, but also for assessing the evolution of the disease. It is therefore essential to know and to use simple, reproducible scores. Although the CDEIS requires a certain amount of training to use, the postoperative recurrence Rutgeerts score easy to perform and providing validated and reproducible information for choice of treatment, should be widely used.

P188 - IBD care in Europe: a comparative audit of Crohn's disease care between Oxford and Milan using the validated National UK IBD Audit Tool

recurrence. Statistical analysis: Kaplan Meier survival method, Chi-square, Student t-test. Results: The two groups were comparable as gender, age at surgery, smoking habits, pattern of CD (perforating / not perforating), and disease duration before surgery. One year after surgery, a small, even if not statistically significant, risk reduction of clinical recurrence was observed in mesalamine treated group ( 7.6%; 95%CI 18.0% to 2.8%). Within 10 years after surgery, the cumulative probability of clinical recurrence and surgical recurrence were similar in the two groups (Log Rank test p = 0.9 and p = 0.1 respectively) (see figure). Conclusion: Mesalamine prophylaxis is not effective for preventing the long-term post-operative recurrence in ileocaecal Crohn’s disease.

P204 - IBD care in Europe: a comparative audit of ulcerative colitis care between Oxford and Milan using the validated National UK IBD Audit Tool

P204 - IBD care in Europe: a comparative audit of ulcerative colitis care between Oxford and Milan using the validated National UK IBD Audit Tool

What is the role of patient education in the care of IBD?

What is the role of patient education in the care of IBD?

What is the role of patient education in the care of IBD?

What is the role of patient education in the care of IBD?

Impact of a nurse−led telephone clinic on quality of IBD care

The course of inflammatory bowel disease is so unpredictable that patients are often well when attending scheduled follow−up hospital appointments. In times of relapse, however, when patients require intervention, clinics are often full or overbooked, limiting the time that clinicians can spend with patients and making rapid access in times of need difficult. This article describes the introduction of a nurse−led telephone clinic, which aimed to improve efficiency and the quality of care provided. A retrospective review shows that it has significantly reduced the non−attendance rate and waiting times for urgent appointments while improving the overall service provided.

SIBLING SUPPORT IN PEDIATRIC INFLAMMATORY BOWEL DISEASE (IBD)

Objective: A supportive family environment is an important predictor of psychological outcomes and medication adherence in pediatric chronic conditions, including IBD. Siblings are a fundamental part of a child's familial and social network, yet little is known about siblings' involvement in IBD care. This ongoing pilot study examines the relationship between healthy siblings' support with IBD care and the quality of life and treatment adherence of children and adolescents with IBD. Method: Participants to date include 12 child and adolescent patients with IBD (83% Crohn's disease) recruited through a Pediatric GI specialty clinic. IBD patients (age range: 11-17 years; M = 13.7) were 58% female, 83% Caucasian, and had well-controlled disease by parent report (75% had not experienced a flare-up in over a year). One healthy sibling (age range: 10-18 years; M = 13.2) from each family was randomly selected for reference; 58% were older than the IBD patient. IBD patients completed measures of IBD-specific quality of life (IMPACT-II), IBD medication adherence (completed conjointly with parent), and sibling support with IBD care. The sibling support measure assessed the IBD patient's perceived frequency of and attitude toward a healthy sibling's involvement in IBD care. Results: Greater frequency of sibling support with IBD care was associated with better overall quality of life (r = .56, p = .06), better body image (r = .57, p < .05), and fewer concerns about IBD treatment (r = .61, p < .05) in IBD patients. IBD patients who reported a positive attitude toward sibling support also reported fewer difficulties with treatment management (r = −.67, p < .05). Conclusion: Preliminary findings suggest that sibling support in IBD care may be associated with higher quality of life and medication adherence in children and adolescents with IBD. Findings may have important implications for family-based interventions in pediatric IBD.

Lebensqualität bei chronisch entzündlichen Darmerkrankungen (CED): die deutsche Version des Inflammatory Bowel Disease Questionnaire (IBDQ-D) zur krankheitsspezifischen Lebensqualitätsmessung - erste Anwendung und Vergleich mit anderen internationalen Fassungen

Health-related quality of life (HRQOL) is an important outcome-parameter in health research and care. The aim of the working group Quality of Life in the Competence Network Inflammatory Bowel Disease (IBD; in the original German: "Kompetenznetz chronisch entzündliche Darmerkrankungen") is to generate instruments for assessment of HRQOL and its implementation as standards in clinical trials, health care and research in IBD. The Inflammatory Bowel Disease Questionnaire (IBDQ) is an international validated disease specific instrument for HRQOL-assessment. A German version of the IBDQ was elaborated and tested in 415 outpatients with Crohn's disease (CD, n = 306) and ulcerative colitis (UC, n = 109). The aim of the study was to compare the results of HRQOL-assessment (IBDQ-D) with international investigations, to correlate HRQOL results with disease activity and to preform a pretest of psychometric properties. International data suggest that the IBDQ-D is a suitable instrument for HRQOL-assessment in CD and UC. For both disease a statistically significant negative correlation with disease activity was found. Tested psychometric properties do not suggest that a revision of the IBDQ-D is required. The IBDQ-D offers the HRQOL-assessment as an primary or secondary outcome in clinical trials in IBD in Germany.

P0670 COST OF PAEDIATRIC INFLAMMATORY BOWEL DISEASE: ONE YEAR PREVALENCE COHORT STUDY

Introduction: Ulcerative Colitis (UC) and Crohn’s disease (CD) are chronic disorders that may require repeated medical interventions. Detailed data describing levels of resource use and cost of illness for IBD in paediatric population are lacking for the UK. The aims of this study is to describe demographics and produce a detailed profile of secondary care resource use and cost for IBD patients managed at a single centre. Methods: Children receiving any form of care for IBD at a tertiary referral centre over a year were identified. Case note review of all confirmed cases was done and resource use during the study time frame was abstracted. Item costs were taken from local and / or national sources. Results: Data relating to 150 IBD patients were analysed (UC: n=59, CD: n=82, Indeterminate Colitis: n = 9) Mean age [SD] and mean duration of disease were: UC 12.6(3.7) yrs and 2.4 yrs; CD 13.7(2.8) yrs and 2.4 yrs. Mean age at diagnosis (UC; CD): 10; 11 yrs. Seven CD patients (8.5%) had perianal disease / fistulating complications. 11 patients (7%) had evidence of extra-intestinal manifestations [sclerosing cholangitis(1), arthritis(1), sacroilitis(1), uveitis(2) and erythema nodusum(5)]. For UC versus CD: Acute flare needing immunosuppressants / elemental diet 47% v 40%; hospitalisation rate 19% v 44%; surgery 6% v 7%. Resource Use- Mean use/patient/year for UC versus CD, respectively: Outpatient Consultations (IBD related): 2.4v2.8; Outpatient Consultations (for extraintestinal manifestations of IBD): 0.09v0.14; Blood tests: 2.4v2.8; Radiology: 0.15v0.17; Day case endoscopies: 0.6v0.5. Inpatient episodes: 0.24v0.5; Length of each inpatient stay (days): 5.5v6.5. Surgical episode: 0.06v0.07. Cost data – see table 1.Table 1: Direct Medical Costs: Total (mean) £s/patient/yearConclusion: In patient care accounts for 63% and 71% of overall direct costs respectively for UC and CD, though is required for a minority of subjects. The information on resource use will help in service planning for patients with IBD.

Quality of care in IBD: reliable questionnaire developed

Quality of care in IBD: reliable questionnaire developed