Quality of care for patients with inflammatory bowel disease in East China

Abstract

received immunomodulatory agents, and more than half of the 8 patients received a suboptimal dose of azathiopurine with no attempt to increase its dosage. CONCLUSION:The quality of care for IBD patients can be further improved. A suboptimal dose of aminosalicylate is used in treatment of patients with CD, especially in those with small intestine involved only. Topical mesalazine is inadequately used in patients with distal or left-sided colitis. Oral or intravenous steroid therapy is not used in some patients with severe IBD. Use of immunomodulatory medication is limited. Larger prospective studies are needed to investigate the quality of care for patients with IBD to establish our own evidence-based guidelines. INTRODUCTIONInflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic disorder of the gastrointestinal tract. The prevalence of IBD is about 1.0/1000 in Western countries [1] . No large scale epidemiological investigation is available on the incidence and prevalence of IBD in China so far, but the diagnosed IBD in China has increased obviously in the past ten years [2] .A number of national and international practice guidelines for management of inflammatory bowel disease are available [3][4][5] . However, the essentials in a step-up treatment have not changed significantly. These practice guidelines are means of bringing evidence-based medicine into full play to improve IBD patient care. However, such [2] . This study was to investigate the impact of such guidelines and the quality of care for a hospital based cohort of patients with IBD from East China. MATERIALS AND METHODS SubjectsIBD patients admitted to Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, between June 2000 and June 2006, were consecutively enrolled in this study. The diagnosis of IBD was confirmed by the criteria established by Chinese Society of Gastroenterology [6] in 2000 and the guidelines issued by the Clinical Services Committee of the British Society of Gastroenterology (BSG) [3] in 2004. The patients not under the care of a gastroenterologist were excluded. Data collectionA retrospective review was performed. Clinical data on demographic information, clinical characteristics of IBD patients, as well as endoscopic, radiologic, surgical and pathological records, confirmed diagnoses, duration and severity of disease, medical therapy, were collected from the inpatient and follow-up clinic visit records and input into an IBD database. Medical therapy included use of oral aminosalicylate, topical therapy, corticosteroid agents, and use of immunomodulatory agents at admission and outpatient clinic visit. Statistical analysisVariables were expressed as mean, while categorical data such as proportion of patients receiving particular therapies and dose of medications were expressed as percentage. Association of patient gender, age, location and severity of disease with suboptimal therapy was analyzed by χ 2 test. P < 0.05 was considered statistically significant. All ...

Asian perspectives in the management of inflammatory bowel disease: Findings from a recent survey

“…The limited use of immunomodulatory medications, such as anti‐TNF, thiopurines and methotrexate might be partly due to cost. On the other hand, as reported in a study of IBD in China, physicians in this region might feel uncomfortable in prescribing these medications because of a lack of evidence and limited experience 36 . Side‐effects, such as neutropenia, might also prevent some physicians from using azathioprine 36 …”

Inflammatory bowel disease in Asia: A systematic review

“…Asian specialists used corticosteroids as maintenance therapy in approximately 25% of CD patients. In contrast, a retrospective review from a single centre in China reported that steroids were not used in up to 30% of patients with severe IBD 191 . Chinese patients may be more concerned about the adverse effects of steroids and refuse to take them at the time of diagnosis 171 …”

“…found that most physicians in Asia favored the use of 5‐Aminosalicylic acid (5‐ASA) medication for the treatment and maintenance of mild‐to‐moderate UC and CD 17 . A suboptimal dose of both oral and topical 5‐ASAs has been reported in China 191 …”

“…In contrast, a retrospective review from a single centre in China reported that steroids were not used in up to 30% of patients with severe IBD. 191 Chinese patients may be more concerned about the adverse effects of steroids and refuse to take them at the time of diagnosis. 171 Sung et al found that most physicians in Asia favored the use of 5-Aminosalicylic acid (5-ASA) medication for the treatment and maintenance of mild-to-moderate UC and CD.…”

Thiopurine Methyltransferase Gene Polymorphisms in Chinese Patients with Inflammatory Bowel Disease

“…Uncertainty regarding the risk of neutropenia and hepatotoxicity prevents the use of thiopurine and therefore affects the quality of care for IBD patients. In a previous study, we found that among the IBD patients for whom immunomodulatory agents were indicated, only 19.6% received them, and more than half of the patients received a suboptimal dose of AZA with no attempt to increase this dosage [7]. …”