Background In inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), nonadherence to biologic therapy increases risk of disease flare. The aim of this study was to identify risk factors for nonadherence. Methods This was a single-center retrospective study evaluating patients with IBD treated at a tertiary care center and prescribed self-injectable biologic therapy using the center’s specialty pharmacy. Adherence was defined using medication possession ratio (MPR). Nonadherence was defined as MPR <0.86. Results Four hundred sixty patients (n = 393 with CD and n = 67 with UC) were evaluated with mean MPR (interquartile range) equaling 0.89 (0.48–1). Overall, 69% of patients were adherent (defined as MPR ≥0.86), 66% of patients with CD and 87% of patients with UC. In univariate analysis, several factors increased risk of nonadherence: CD diagnosis, insurance type, psychiatric history, smoking, prior biologic use, and narcotic use (P < 0.05). In multivariable analysis, Medicaid insurance (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.85–15.6) and CD diagnosis (OR, 2.8; 95% CI, 1.3–6.0) increased risk of nonadherence. In CD, as the number of risk factors increased (narcotic use, psychiatric history, prior biologic use, and smoking), the probability of nonadherence increased. Adherence was 72% in patients with 0–1 risk factors, decreasing to 62%, 61%, and 42% in patients with 2, 3, and 4 risk factors, respectively (P < 0.05). Conclusions This study identified risk factors for nonadherence to biologic therapy. In patients with CD, the probability of nonadherence increased as the number of risk factors increased.
ultidisciplinary clinics (MDCs) are an emerging model of health care delivery, offering patients coordinated care services to diagnose problems early and develop cohesive treatment plans. MDCs are commonly used in oncology, (1) type 2 diabetes mellitus (T2DM), (2) and women's health, (3) where they improve patient satisfaction and clinical and financial outcomes. In this review, we examine current MDC models and share a framework for patients with NAFLD to guide development of future multidisciplinary NAFLD programs. Multidisciplinary Care Models in MedicineWhile traditional health care delivery models consist of physicians assessing patients independently, MDCs promote coordinated care by integrating consultations and centralizing into a single clinic space. MDCs are often seen in oncology practices where multiple consultations are coordinated by a navigator into a single visit. (4) Many also have weekly conferences involving multiple providers who discuss and coordinate management plans and follow-up. (4,5) These models promote evidence-based, patient-centered plans and have been shown to improve clinical outcomes. (5) For example, a single-day MDC for patients with liver cancer that features a central clinical coordinator and frequent team meetings reported improvement in diagnosis, treatment, patient-provider communication, and satisfaction. (6) Despite variations in structure, MDCs are also well received by patients. In traditional sequential referral models of care, patients perceive poorer physician communication, inefficient use of time, misdiagnosis, mistreatment, and decreased satisfaction, which can lead to seeking a second opinion. (7) Conversely, patients in MDCs enjoy improved patient-physician communication and increased efficiency of travel time, appointments, and testing. (4,8) MDCs also improve patient experience and quality of life in cancer care, while reducing health care costs. (9) Multidisciplinary Care in NAFLDThe complexity of NAFLD and its associations with metabolic disease, cardiac and diabetic complications, and lifestyle factors make it ideal for multidisciplinary care. Patients with metabolic syndrome are at high risk for developing NAFLD complications, such as cirrhosis and HCC. (10) Data also suggest
In fact, consistent with other studies of survivors from treatment for primary gastrointestinal tract tumors, 2,3 prognosis improves over time. There are some open-source data sets of cancer survival prediction calculators that have been developed to facilitate pragmatic discussions between patients and clinicians pertaining to conditional survival for select solid tumors. 4 As these outcome tools are refined to include individualized patient-level "-omic" information, nextgeneration outcome prediction tools have the potential to be more accurate in estimating outcome for cancer survivors.
Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare cause of nonthrombotic, noninflammatory ischemic colitis. IMHMV classically presents in men with abdominal pain and bloody diarrhea and is frequently misdiagnosed as inflammatory bowel disease. However, IMHMV causes a more protracted, relapsing course of abdominal pain that does not respond to medical therapy. The diagnosis can be secured by colonoscopic biopsy. Surgical resection is curative and should be considered even in high-risk patients. Here, we describe a case of IMHMV diagnosed preoperatively in a post-liver transplant patient with residual portal hypertension who ultimately underwent successful surgical resection.
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