Management and healthcare of patients with inflammatory bowel disease (IBD) can be a very difficult task. According to a German study, development of activities that involve the patient in the disease management process can improve overall patient care.
These findings were reported in the study titled, “Quality of care in inflammatory bowel disease: results of a prospective controlled cohort study in Germany (NETIBD),” featured in the journal Clinical and Experimental Gastroenterology.
IBD is a very complex disease that can affect several aspects in a patient’s health and life. Current guidelines recommend comprehensive and problem-oriented care to manage the wide spectrum of problems implicated. But his can be a very demanding task for healthcare practitioners.
Multidisciplinary teams and clinical centers have been identified as the best response for improved IBD patient care. But the current German healthcare system cannot be included in such categories. Indeed, it is a complex system and poorly integrated.
If a patient presents clinical symptoms of IBD in a general practitioner consultation in Germany, it will then be referred to a specialist in a gastroenterology practice. In this situation, if the case requires highly specialized care including immunosuppressants or biologics treatment regimens, the patient is then treated in tertiary care centers.
This multi-site IBD management makes it difficult to get access to patients and treatment information, highlighting the need for evidence-based IBD pathways to improve the quality of IBD healthcare.
In the NETIBD study, investigators evaluated the acceptance of some IBD pathways recommended in a real-life clinical setting and implications for patients’ care. These recommendations included questionnaire-based assessments of the patient’s physical and psychosocial problems, individualized care, improvement of patient education by participating in a two-day education program, and integrative practitioners collaborating by participating in periodic interdisciplinary case conferences.
A total of 349 patients were included in the study and followed-up for 12 months. The participants were divided into groups, one in which the IBD pathways were implemented, and a second group that maintained the standard healthcare regimen.
Throughout the study no differences in health-related quality of life and social participation were observed between the two groups. The IBD patients who were in the intervention group demonstrated improved self-management skills. This improved capacity led to a reduction of steroid-based medication regimens in the group. Only 8 percent of the patients continue receiving such therapies, compared to 20 percent of patients in the control group.
“The implementation of some of the recommendations of the IBD pathways to improve the quality of care of IBD patients treated in gastroenterology practices faced obstacles from doctors and patients alike,” the investigators wrote.
Although both patients and clinicians were open to questionnaire-based approaches for patients and patient care overall assessments, the educational classes for patients and case conferences for doctors were found to be less successful.
“Nevertheless, there should be [a continued offering] of these classes, one reason being the observed tendency toward optimizing IBD therapy resulting from it,” they wrote.
This study failed to demonstrate the benefits of this IBD management intervention. Still, the investigators concluded that the observed beneficial effects on patients’ self-management skills should encourage the evaluation of more intensive and addressee-centered activities.