Variations in the medical treatment of inflammatory bowel disease among gastroenterologists

Singh, Shailendra; Chowdhry, Monica; Umar, Shifa; Bilal, Mohammad; Clarke, Kofi

doi:10.1093/gastro/gox005

Cited by 14 publications

(15 citation statements)

References 11 publications

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“…A lack of understanding and of the available literature has created a sense ambiguity surrounding the roles of PCPs in the management of IBD. We found gaps in the continuity of care between secondary and primary healthcare professionals; for example, issues related to the information provided to patients by healthcare professionals may be contradictory, [41][42][43]74 there can be a lack of educational tools to assist healthcare professionals in the management of patients with IBD, and there is a paucity of published literature on the primary care management of IBD. 30,71 In particular, studies showed inconsistent or variable IBD care for patients, 7,58 knowledge gaps among healthcare professionals, [41][42][43]48,54,56 a lack of guidelines for primary care practitioners to provide quality of care, 30,48 and a communication gap between patients and specialists/GPs affecting the delivery of IBD care.…”

Section: Discussionmentioning

confidence: 99%

Roles of healthcare professionals in the management of chronic gastrointestinal diseases with a focus on primary care: A systematic review

et al. 2019

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Background and aim Inflammatory bowel disease (IBD) refers to a group of complex and chronic conditions that requires long‐term care delivered by a group of healthcare professionals through a multidisciplinary care model. We conducted a systematic review to examine and understand the role of healthcare professionals in the primary care management of IBD, and identify the gaps in IBD management that could be filled by primary care providers such as general practitioners (GPs) and pharmacists. Methods The search strategy retrieved published studies from five databases, and eligible articles were assessed for quality. A gray literature search of the websites of organizations was also undertaken. Results Twenty‐one studies were included, of which 19 were peer‐reviewed research articles and two reports were from organizational bodies. Although studies have shown the roles of GPs, pharmacists, dietitians, and psychologists in IBD management, nurses and gastroenterologists were the key drivers delivering specialized care to IBD patients. Many key services are accessible only for hospital inpatients (tertiary care) or through outpatient clinics (secondary care) with an absence of a multidisciplinary approach including GPs and pharmacists. Conclusion Gastroenterologists and nurses have an important role in the delivery of care to patients with chronic gastrointestinal diseases including IBD, coeliac disease, irritable bowel syndrome, and functional dyspepsia. The role of nurses includes provision of specialized care to IBD patients, as well as supportive care such as education, monitoring of therapy, and ongoing assistance. The available evidence shows many opportunities for primary care providers to play a more active role in the management of IBD patients.

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Section: Discussionmentioning

confidence: 99%

Roles of healthcare professionals in the management of chronic gastrointestinal diseases with a focus on primary care: A systematic review

et al. 2019

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“…Singh et al . highlighted the variations in medication prescription within a single high‐volume center, which persists after adjusting for disease and patient characteristics . They reported that the prescription of biologics and immunomodulators is higher in IBD specialists than other general gastroenterology physicians .…”

Section: Discussionmentioning

confidence: 99%

“…11 Singh et al highlighted the variations in medication prescription within a single high-volume center, which persists after adjusting for disease and patient characteristics. 12 They reported that the prescription of biologics and immunomodulators is higher in IBD specialists than other general gastroenterology physicians. 12 In our study, the use of immunomodulators in CD and the use of biologics and immunomodulators in UC was higher at tertiary hospitals than at general hospitals/community hospitals/ clinics, whereas the use of biologics in CD was lower at tertiary hospitals than at general hospitals/community hospitals/ clinics (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…12 They reported that the prescription of biologics and immunomodulators is higher in IBD specialists than other general gastroenterology physicians. 12 In our study, the use of immunomodulators in CD and the use of biologics and immunomodulators in UC was higher at tertiary hospitals than at general hospitals/community hospitals/ clinics, whereas the use of biologics in CD was lower at tertiary hospitals than at general hospitals/community hospitals/ clinics (Table 3). Considering that there are more IBD specialists and more severe patients at tertiary hospitals than at general hospitals/community hospitals/ clinics, the higher rate of biologics use at general hospitals/ community hospitals/clinics than at tertiary hospitals may suggest that a standardized treatment strategy for biologics use in CD patients is needed, and further discussion of the appropriate starting point for biologics use should be undertaken.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have examined such differences between countries, high-volume referral centers, or physicians within a single high-volume center. [8][9][10][11][12] However, there have been no studies investigating regional differences nationwide. Additionally, all studies on this topic have been conducted in Western countries.…”

Section: Introductionmentioning

confidence: 99%

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Regional variations in the use of biologics and immunomodulators among Korean patients with inflammatory bowel diseases

Han

Jung

Cheon

et al. 2019

J of Gastro and Hepatol

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Background and Aim Variation in medical care can be an obstacle to improving quality and outcome of treatment. We conducted a nationwide, population‐based study to identify regional variations in medication prescription rates in Korean patients with inflammatory bowel diseases (IBDs). Methods Using the National Health Insurance claims, we collected data on patients diagnosed with IBD (8974 cases of Crohn's disease [CD] and 17 167 cases of ulcerative colitis [UC]) between 2010 and 2016. Results Overall rates of biologics (infliximab or adalimumab) use in CD and UC were 19.6% and 6.1%, respectively, and those of immunomodulator (azathioprine or 6‐mercaptopurine) use were 66.9% and 20.4%, respectively. The average periods from diagnosis to first biologics use for CD and UC were 1.6 and 1.8 years, respectively, and those of immunomodulators were 0.6 and 1.3 years, respectively. In Seoul, Daegu, and Busan, three major cities in Korea, biologics prescription rates for CD were 20.7%, 22.9%, and 14.6%, respectively, and those for UC were 7.3%, 6.7%, and 4.5%, respectively. In the top 7 regions with the highest number of patients in Seoul, there were 3.6‐fold and 3.2‐fold variations between regions with the highest and lowest frequency of biologics use in CD and UC, respectively. In addition, there were 1.6‐fold and 2.8‐fold variations between regions with the highest and lowest frequency of immunomodulator use for CD and UC, respectively. Conclusions Regional variation exists in medication prescription rates within a single city as well as nationwide, suggesting that standardization of IBD treatment is necessary in Korea.

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Definition of mild to moderate ulcerative colitis in clinical trials: A systematic literature review

et al. 2022

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We performed a systematic review to investigate the definition of mild to moderate active ulcerative colitis (UC), and to describe predictors of good response to treatment in clinical trials assessing 5‐ASA and/or budesonide. Thirty‐nine randomized controlled trials were included. The UC Disease Activity Index (UCDAI) was the most frequent score used for defining mild to moderate active UC (16 studies, 41%), followed by Clinical Activity Index in 11 studies (28.2%). Four different cut‐offs were used to define mild to moderate active UC using the UCDAI. The most frequently reported predictors of good response to treatment was a mild and moderate disease activity. There is heterogeneity in the definition of mild to moderate active UC in randomized clinical trials. A standardized definition of mild to moderate active UC used for inclusion of patients in clinical trials is needed.

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Variations in the medical treatment of inflammatory bowel disease among gastroenterologists

Cited by 14 publications

References 11 publications

Roles of healthcare professionals in the management of chronic gastrointestinal diseases with a focus on primary care: A systematic review

Roles of healthcare professionals in the management of chronic gastrointestinal diseases with a focus on primary care: A systematic review

Regional variations in the use of biologics and immunomodulators among Korean patients with inflammatory bowel diseases

Definition of mild to moderate ulcerative colitis in clinical trials: A systematic literature review

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