Distance to Specialist Care and Disease Outcomes in Inflammatory Bowel Disease

Conway, Grace; Tan, Wei; Andrews, Elizabeth; Garber, John J.; Yajnik, Vijay; Ananthakrishnan, Ashwin N.

doi:10.1097/mib.0000000000001133

Cited by 32 publications

(22 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The other reason could be that patients with lower income or without commercial private insurance cannot afford such expensive but effective biological agents, which resulted in a lower level of remission. This is consistent with that reported previously that travelling long distances to obtain medical treatment for IBD hinders regular care and adversely affects the outcomes—especially increasing the risk of needing IBD-related surgery [ 25 ].…”

Section: Discussionsupporting

confidence: 92%

Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study

Zhu

Shi

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

Background The increasing incidence of inflammatory bowel disease (IBD) has imposed heavy financial burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing patients with IBD about disease treatment budgets and health care strategies. Objective The aim of this study was to evaluate the economic status and medical care access of patients with IBD through the China Crohn’s & Colitis Foundation web-based platform in China. Methods Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat. Participants were asked to complete a 64-item web-based questionnaire. Data were collected by the Wenjuanxing survey program. We mainly focused on income and insurance status, medical costs, and access to health care providers. Respondents were stratified by income and the associations of income with medical costs and emergency visit times were analyzed. Results In this study, 3000 patients with IBD, that is, 1922 patients with Crohn disease, 973 patients with ulcerative colitis, and 105 patients with undetermined colitis were included. During the last 12 months, the mean (SD) direct and indirect costs for per patient with IBD were approximately US $11,668.68 ($7944.44) and US $74.90 ($253.60) in China. The average reimbursement ratios for most outpatient and inpatient costs were less than 50%. However, the income of 85.5% (2565/3000) of the patients was less than ¥10,000 (US $1445) per month. Approximately 96.5% (2894/3000) of the patients were covered by health insurance, but only 24.7% (741/3000) of the patients had private commercial insurance, which has higher imbursement ratios. Nearly 98.0% (2954/3000) of the patients worried about their financial situation. Thus, 79.7% (2392/3000) of the patients with IBD tried to save money for health care and even delayed their medical treatments. About half of the respondents (1282/3000, 42.7%) had no primary care provider, and 52.2% (1567/3000) of the patients had to visit the emergency room 1-4 times per year for the treatment of their IBD. Multivariate analysis revealed that lower income ( P =.001) and higher transportation ( P =.004) and accommodation costs ( P =.001) were significantly associated with the increased number of emergency visits of the patients. Conclusions Chinese patients with IBD have enormous financial burdens and difficulties in accessing health care, which have increased their financial anxiety and inevitably influenced their disease outcomes. Early purchase of private insurance, thereby increasing the reimbursement ratio for medical expenses, and developing the use of telemedicine would be effective strategies for saving on health care costs.

show abstract

Section: Discussionsupporting

confidence: 92%

Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study

Zhu

Shi

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…A recent study from the USA found that increased distance of IBD patients’ home to a referral IBD center was associated with increased odds of surgery, biological use, and immunomodulator use. 40 Every increase of 10 miles from the patients’ home to the center resulted in a 9% increase in surgical risk and a 14% increase in the use of biological therapy. 40 Similarly, German patients with IBD were seen less frequently, were prescribed fewer medications, and were less likely to undergo surveillance colonoscopy if they lived in low-density or rural areas.…”

Section: Discussionmentioning

confidence: 99%

“… 40 Every increase of 10 miles from the patients’ home to the center resulted in a 9% increase in surgical risk and a 14% increase in the use of biological therapy. 40 Similarly, German patients with IBD were seen less frequently, were prescribed fewer medications, and were less likely to undergo surveillance colonoscopy if they lived in low-density or rural areas. 41 …”

Section: Discussionmentioning

confidence: 99%

Rural and urban disparities in the care of Canadian patients with inflammatory bowel disease: a population-based study

Benchimol¹,

Kuenzig²,

Bernstein³

et al. 2018

CLEP

View full text Add to dashboard Cite

Background and aimsCanada’s large geographic area and low population density pose challenges in access to specialized health care for remote and rural residents. We compared health services use, surgical rate, and specialist gastroenterologist care in rural and urban inflammatory bowel disease (IBD) patients in Canada.MethodsWe used validated algorithms that were applied to population-based health administrative data to identify all people living with the following three Canadian provinces: Alberta, Manitoba, and Ontario (ON). We compared rural residents with urban residents for time to diagnosis, hospitalizations, outpatient visits, emergency department (ED) use, surgical rate, and gastroenterologist care. Multivariable regression compared the outcomes in rural/urban patients, controlling for confounders. Provincial results were meta-analyzed using random-effects models to produce overall estimates.ResultsA total of 36,656 urban and 5,223 rural residents with incident IBD were included. Outpatient physician visit rate was similar in rural and urban patients. IBD-specific and IBD-related hospitalization rates were higher in rural patients (incidence rate ratio [IRR] 1.17, 95% CI 1.02–1.34, and IRR 1.27, 95% CI 1.04–1.56, respectively). The rate of ED visits in ON were similarly elevated for rural patients (IRR 1.53, 95% CI 1.42–1.65, and IRR 1.33, 95% CI 1.25–1.40). There were no differences in surgical rates or prediagnosis lag time between rural and urban patients. Rural patients had fewer IBD-specific gastroenterologist visits (IRR 0.79, 95% CI 0.73–0.84) and a smaller proportion of their IBD-specific care was provided by gastroenterologists (28.3% vs 55.2%, P<0.0001). This was less pronounced in children <10 years at diagnosis (59.3% vs 65.0%, P<0.0001), and the gap was widest in patients >65 years (33.0% vs 59.2%, P<0.0001).ConclusionThere were lower rates of gastroenterologist physician visits, more hospitalizations, and greater rates of ED visits in rural IBD patients. These disparities in health services use result in costlier care for rural patients. Innovative methods of delivering gastroenterology care to rural IBD patients (such as telehealth, online support, and remote clinics) should be explored, especially for communities lacking easy access to gastroenterologists.

show abstract

“…Despite effective therapies, a significant proportion of patients have suboptimal short and long-term outcomes. The obstacles for effective treatment outcomes include insufficient monitoring of symptoms, difficulty in getting timely access to a gastroenterologist,[2] and lead time to an effective treatment. [3]…”

Section: Introductionmentioning

confidence: 99%

Smartphone-based videoconference visits are easy to implement, effective, and feasible in Crohn’s Disease Patients: A prospective cohort study

Yılmaz

Duman

2021

Preprint

View full text Add to dashboard Cite

Purpose: Crohn's Disease patients require life-long follow-up resulting in frequent hospital visits, which is a burden for this population. While telehealth has been firmly established, the usefulness of remote management, mobile technology's role is missing. The purpose of this study is to determine the feasibility and effectiveness of smartphone-based real-time video visits. Methods: We prospectively randomised 139 patients either to a traditional (FTF) or online clinic (OLV) in a tertiary university hospital between March 2020- September 2020. We measured patients' satisfaction with clinic metrics such as disease activity, visit outcomes, socioeconomic parameters, and travel expenses. Results: Satisfaction scores with the provider (p<0.05), clinical process (p<0.001), and total satisfaction scores (p<0.001) were significantly higher at OLV compared to FTF.Median 47km travel distance and 49 minutes travel time per visit saved. An average of US$12.24 potential travel costs were saved per appointment. Eighty-five per cent of the patients met the needs at online visits and did not require a face to face visit Discussion: In this study, we show for the first time smartphone-based real-time video visit telehealth model has high acceptance, easy to implement, effective and saves travel cost and time. This study helps physicians to overcome distance managing Crohn's Disease in a simple way. Further investigations are needed for its effect on long-term disease course

show abstract

Distance to Specialist Care and Disease Outcomes in Inflammatory Bowel Disease

Cited by 32 publications

References 34 publications

Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study

Economic Burden and Health Care Access for Patients With Inflammatory Bowel Diseases in China: Web-Based Survey Study

Rural and urban disparities in the care of Canadian patients with inflammatory bowel disease: a population-based study

Smartphone-based videoconference visits are easy to implement, effective, and feasible in Crohn’s Disease Patients: A prospective cohort study

Contact Info

Product

Resources

About