Access to inflammatory bowel disease speciality care: the primary healthcare physician perspective

Abstract

Background There is little literature related to access to inflammatory bowel disease (IBD) care that incorporates the perspective of key system stakeholders, such as primary healthcare providers (PHCP), despite their clear and integral role in facilitating access. Objective This study aimed to identify barriers to referring patients to speciality IBD care as perceived by referring PHCP. In particular, we sought to understand PHCP satisfaction with the current IBD specialist referral system, as well as indicators of geographic variance to access. Methods A population-based survey was mailed out to currently practising PHCPs who have referred or who are currently referring patients to IBD speciality care in Nova Scotia (Canada). Descriptive statistics and multivariate analyses were performed. Qualitative comments were themed using framework analysis to identify key barriers. Results The majority of PHCP (57%) were dissatisfied with the current referral process due to long patient wait times and perceived system inefficiency. Key areas of geographic variance in access included access to speciality care in the community and patient wait times. PHCPs suggested ideas to improve access including increased gastroenterologist supply, particularly in rural areas, and the creation of a provincial centralized referral and triage process. Conclusions PHCPs play an important role in identifying and managing patients with IBD in partnership with gastroenterologists. This study identifies key PHCP perceived barriers that may prevent patients from accessing speciality IBD care. Understanding and addressing barriers to access from multiple stakeholder perspectives, including PHCPs, has the potential to support informed system redesign and overcome access inequities.

Application of Health Education Based on Phased Transition Theory Model in Continuous Nursing for Patients with Inflammatory Bowel Disease

“…The phased transition theoretical model is a method that focuses on the process and needs of human behavior change, which can help to change the unhealthy behavior of patients and promote the development of their healthy behavior [ 6 ]. This theoretical model has been proved to have good effects in healthy education and nursing of chronic diseases such as asthma and diabetic nephropathy [ 7 ]. However, the value of its combination with continuous care in the clinical care of IBD patients is unclear.…”

“…is theoretical model has been proved to have good e ects in healthy education and nursing of chronic diseases such as asthma and diabetic nephropathy [7]. However, the value of its combination with continuous care in the clinical care of IBD patients is unclear.…”

Subclinical bowel inflammation increases healthcare resources utilization and steroid use before diagnosis of inflammatory bowel disease

“…Further, these subjects would benefit from those initiatives that ensure appropriate referral processes and short waiting times in order to initiate adequate and tailored management, but this aspect seems to be still insufficient in some regions. 26,27 This study has some limitations that should be considered. First, this is a retrospective registry-based study using administrative data from a single region, that may limit our ability of describing more in detail certain outcomes like steroid use and generalizing our results.…”

“…In this setting, fecal calprotectin or other non‐invasive biomarkers will have the opportunity to individualize the risk of disease‐modification strategies. Further, these subjects would benefit from those initiatives that ensure appropriate referral processes and short waiting times in order to initiate adequate and tailored management, but this aspect seems to be still insufficient in some regions 26,27 …”

“…Further, these subjects would benefit from those initiatives that ensure appropriate referral processes and short waiting times in order to initiate adequate and tailored management, but this aspect seems to be still insufficient in some regions. 26 , 27 …”