Inflammatory Bowel Disease Care in Brazil: How It Is Performed, Obstacles and Demands From the Physicians’ Perspective

Abstract

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the “Study Group of Inflammatory Bowel Disease of Brazil” (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn’s disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics “biological therapy failure” and “new drugs” were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country’s regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

Long-term effectiveness and safety of ustekinumab in bio-naïve and bio-experienced anti-tumor necrosis factor patients with Crohn’s disease: a real-world multicenter Brazilian study

“…Crohn's disease (CD) is a chronic, progressive, and idiopathic immune-mediated disorder that can involve any segment of the gastrointestinal tract, likely resulting in negative impacts on the quality of life and work productivity of affected patients [1][2][3][4][5][6]. The accurate incidence and prevalence of CD in Brazil are still unknown; however, recent regional reports suggest that the incidence of the disease has been increasing over the past years [7].…”

Anti-TNF therapy for ulcerative colitis in Brazil: a comparative real-world national retrospective multicentric study from the Brazilian study group of IBD (GEDIIB)

“…Another important limitation was a natural selection bias, a common feature of the retrospective and observational study design, where more severe patients could be directed to IFX use. However, these findings highlight the that physicians may confront in the management of IBD patients in our country [ 37 ]. The observational nature of this study carries the inherent biases associated with the retrospective study design.…”

Access to High-Cost Biological Agents: Perceptions of Brazilian Patients with Inflammatory Bowel Diseases

“…Currently, despite economic difficulties in Brazil, biological therapy for patients with IBD is made available by the National Unified Health Care System (SUS) through the Specialized Component of Pharmaceutical Assistance (CEAF), or through a request from health operators for those who have access to health insurance. Within the scope of the public system, the Ministry of Health carries out centralized purchases and forwards them to the states that carry out operational management [ 15 ]. Even though Brazil has three different classes of approved biological drugs (anti-TNF, anti-integrin, and anti-interleukin) and a JAK inhibitor (tofacitinib), access to biological/small molecule treatment is difficult, and there are differences between patients in the public and private health systems.…”