Background Gender biases in referral may impact patient care, and may perpetuate gender-based pay inequities. Referral patterns of male and female patients to male and female gastroenterologists (GIs) have not been previously characterized. Purpose We aimed to determine the extent to which female patients referred for consultation to gastroenterologists were preferentially channeled to female practitioners, and to further assess how gender-based referral channeling has changed over time. Method We used data from IC/ES Ontario to identify all residents of Ontario, Canada who had had a new consultation with an Ontario gastroenterologist in an ambulatory setting between Jan 1, 2002, to Dec 31, 2019, with time subdivided into early (2002-2007), mid (2008-2013), and late (2014-2019) periods. New consults were defined as any GI consultation where there had been no ambulatory visit with a different GI in the two years prior. The primary outcome was the difference in the proportion of female patients seen by male GIs vs female GIs. Descriptive statistics were used to compare patient and GI characteristics. Continuous variables were analyzed by the t-test, with p<0.05 suggestive of statistical significance. Odds ratios and their 95% CIs for the association of referral to a female GI and being a female patient were calculated. Result(s) From 2002 to 2019, the proportion of female gastroenterologists in Ontario increased from 15% (15/100) to 27% (78/292). During this 18-year period, female GIs saw a total of 17% of all consultations. Male GIs saw a greater number of consultations per year, though the gap closed over the period of observation. Specifically, each female GI in 2014-19 saw, on average, 776 patients (±41.8) compared to 578 (±59.2) in 2002-2007 (p<0.005) – a 34.5% increase; each male GI in 2014-2019 saw, on average, 905 patients (±7.2) compared to 824 (±25.0) in 2002-2007 (p<0.005) – a 9.8% increase. Female patients made up 56.7% of the total consultations over 2002-2019. There was evidence of channeling of female patients to female providers; in the early period, 72.4% of consults seen by female GIs were female, compared to only 56.8% of consults seen by male GIs (OR 2.07, 95% CI [1.98, 2.17]. By the late era (2014-2019), 64.1% of consults seen by female GIs were for female patients, compared to 53.3% for male GIs (OR 1.62, 95% CI [1.59, 1.66]. Image Conclusion(s) There has been a significant increase in the number of female GIs in Ontario in recent years, and female GIs are seeing significantly greater patient volumes in the later eras in comparison to earlier eras. Female GIs receive a higher proportion of consultations for female patients, though this proportion is declining over time. The extent to which this gender-based referral channelling influences patient care, patient outcomes or influences the gender-based provider pay gap requires further exploration. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; IMAGINE-SPOR Disclosure of Interest None Declared
Background Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), impacts health-related quality of life (HRQoL). In pregnancy and postpartum, distinguishing IBD-specific symptoms is challenging. The extent to which pregnancy and disease activity affects HRQoL in IBD patients remains unknown. Aims To assess women with and without IBD at pre-, intra-, and postpartum timepoints, and examine the impact of pregnancy, IBD type, and disease activity on IBD-related HRQoL. Methods Preconception (PC) and pregnant women aged ≥18 years with and without IBD completed surveys at various timepoints from PC to 12 months postpartum (PP). The Short IBD Questionnaire (SIBDQ) is a validated survey that assesses HRQoL in IBD patients and covers bowel, emotional, systemic, and social domains; a higher score indicates a better HRQoL. Participants completed SIBDQ and modified Harvey Bradshaw Index (mHBI) for CD or partial Mayo score (pMayo) for UC. Clinically active disease was defined as mHBI ≥5 or pMayo ≥2; objectively active disease was defined as C-reactive protein (CRP) ≥8.0mg/L or fecal calprotectin (FC) ≥250mg/kg. Continuous variables were analyzed by the t-test whereas categorical variables were assessed by the chi-squared test, with p<0.05 suggestive of statistical significance. Results 61 patients with IBD (36 UC, 25 CD) and 12 healthy controls were included. In IBD patients, SIBDQ was positively associated with income during PC, but not once patients became pregnant. No association was found with education level. There were no significant differences in mean SIBDQ between study timepoints. SIBDQ was significantly lower in IBD patients with clinically active disease at all trimesters of pregnancy and all PP timepoints, but not at PC. SIBDQ was significantly lower in patients with high CRP during trimester 1 (T1), but not later in pregnancy. Generally, SIBDQ was lower in patients with higher FC; SIBDQ bowel scores were significantly lower in patients with high FC at T2, T3, and PP6. During PC, SIBDQ was significantly higher in UC patients than CD patients; this difference was lost in pregnancy. During PP, SIBDQ bowel and social scores were significantly lower in UC patients than CD patients at 6 months. Compared to healthy controls, IBD patients had significantly lower SIBDQ at PC, T1, and T2; they also had significantly lower SIBDQ bowel scores in early PP, which resolved by 12 months. In IBD patients, no association was found between PP SIBDQ scores and breastfeeding or delivery method. Conclusions Women with IBD experience worse HRQoL in early pregnancy, and worse bowel-related HRQoL postpartum. UC patients have better PC HRQoL but suffer worse postpartum bowel-related HRQoL than CD patients. Overall, SIBDQ correlates well with clinical and biochemical disease activity during pregnancy and postpartum. Funding Agencies Women and Children’s Health Research Institute (WCHRI), Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta Faculty of Medicine
Background Women with inflammatory bowel disease (IBD) with poor IBD-specific reproductive knowledge experience more voluntary childlessness. Poor knowledge is associated with fear of IBD medications in pregnancy; this must be addressed as active IBD at preconception (PC) correlates with worse intrapartum disease and poor fetal outcomes. The Pregnancy IBD Decision Aid (PIDA), developed by an international multidisciplinary team following International Patient Decision Aids Standards, is an interactive online tool that offers personalised decision support on fertility, pregnancy, and medications in IBD (Fig). Aims To assess PIDA’s impact on knowledge and quality of decision-making among PC and pregnant patients with IBD, and to evaluate its feasibility as a tool for patients and clinicians. Methods PC and pregnant women aged 18–45 with IBD, recruited in Canada and Australia, completed questionnaires pre and post PIDA to assess quality of decision-making (Decisional Conflict Scale, DCS; Self-Efficacy Score, SES) and IBD in pregnancy knowledge (Crohn’s and Colitis Pregnancy Knowledge Score, CCPKnow). DCS assesses if a decision is informed, aligned with personal values, and would be implemented. SES measures belief in one’s ability to make informed decisions. Patients and clinicians (gastroenterology, obstetrics, primary care) also completed feasibility surveys. Paired t-test assessed for differences pre and post PIDA. Results DCS and SES were completed by 74 patients (42 Crohn’s disease, 32 ulcerative colitis); 41 PC and 33 pregnant. DCS improved significantly post PIDA (effect size 0.44, p<0.0001); this was observed in PC patients regarding pregnancy planning with IBD, and in pregnant patients regarding peripartum IBD medication management. SES of PC but not pregnant patients improved significantly post PIDA (effect size 0.32 vs 0.24, p=0.0001 vs 0.0525). In both cohorts, CCPKnow improved significantly post PIDA (n=76, effect size 0.66, p<0.0001). Patients (n=73) assessed PIDA feasibility. Mean scores for length (3.05±0.44), readability (3.09±0.5), and content amount (2.91±0.81) were perceived as appropriate (1=limited, 5=excessive). Perceived usefulness of PIDA was high among all patients (4.09±0.93; 5=most useful). Clinicians (n=14) believed PIDA had appropriate length, readability, and content amount, and deemed PIDA useful to patients (4.6±0.8) and themselves (4.8±0.8) for clinical practice. Conclusions PIDA improved knowledge and quality of decision-making in PC and pregnant patients with IBD. Patients developed a strengthened belief in their ability to make informed, effective decisions, and both patients and clinicians found PIDA feasible. PIDA is an accessible tool that can empower women with IBD to make evidence-based decisions about pregnancy and may ultimately reduce voluntary childlessness. Funding Agencies Mount Sinai Hospital Resident Research Grant; Gastroenterological Society of Australia Rose Amarant Grant; Women and Children’s Health Research Institute (WCHRI); Clinical/Community Research Integration Support Program (CRISP); Merck Better Care, Healthy Communities Funding Program
Background Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory bowel diseases (IBD) that affect a significant portion of women in childbearing years. It is known that disease activity in early pregnancy negatively impacts obstetrical and perinatal outcomes, but the impact on infant growth is largely unknown. Aims The objective of this study was to compare the growth of infants born to women with active IBD during pregnancy versus those born to women with IBD in remission during pregnancy. Methods We conducted a prospective cohort study in a Canadian tertiary centre comprised of 98 pregnant women with IBD (63 with UC and 35 with CD) and 13 healthy pregnant women. We collected maternal demographic at trimester 1 and assessed disease activity at each trimester using clinical disease scores and fecal calprotectin. We then collected perinatal outcomes at delivery and followed the infants’ growth and feeding habits up to 12 months of age. Results A total of 103 mother-infant pairs were included in the study, of which 88 infants were born to women with IBD, and 15 born to women with active disease at trimester 1. Active disease at trimester 1 was associated with more adverse obstetrical outcomes, reduced 1-minute and 5-minute APGAR scores and more frequent NICU admissions. Infants born to women with active trimester 1 disease had reduced weight-for-age and length-for-age Z scores up to 6 months of age, in the absence of difference in feeding patterns. In addition, women with active disease at trimester 1 had increased expression of IL-8 and IFN-γ compared to those with trimester 1 remission. Conclusions Active IBD during first trimester is correlated with decreased infant weight and height up to 6 months of age, suggesting that strict disease control during first trimester, or even preconception, is essential for optimizing infant growth and perinatal outcomes. Funding Agencies None
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