The CCFA National Survey of Health Care Access in Inflammatory Bowel Disease (IBD): ACG Governors Award for Excellence in Clinical Research

Abstract Background Inflammatory bowel disease (IBD) is a chronic digestive condition with significant complications if left untreated. Rural dwellers face barriers to access specialised health care, which is located in larger urban centres. We aimed to contrast health care utilization (outpatient gastroenterology visits, colonoscopies, claims for IBD medications, IBD-specific and IBD-related hospitalizations, and surgeries for IBD) between rural and urban residents diagnosed with IBD in the Canadian province of Saskatchewan (SK). Methods We completed a population-based retrospective study using SK administrative health databases (hospital discharge abstracts, medication claims, and physician billings) between the 1999 to 2016 fiscal years. A validated IBD algorithm requiring multiple health care contacts was used for case ascertainment. IBD incidence cases were identified by requiring eight years of continuous health care coverage without IBD health care contacts before the date of diagnosis. Cases were assigned to a rural or urban location based on their residential postal codes at the date of IBD diagnosis. Study outcomes were measured from IBD diagnosis to the end of the study period or end of health care coverage. Cox proportional regression models were used to evaluate the associations between rural-urban residence and each study outcome. Models were adjusted by sex, age, neighbourhood income quintile at IBD diagnosis, and disease type (Crohn’s disease and ulcerative colitis). Adjusted hazard ratios (HR) and 95% confidence intervals (95%CI) were reported. Results We identified 5,173 IBD incident cases in SK between 1999 and 2016; 1,544 (29.8%) individuals were living in rural locations at the date of diagnosis. Compared to urban dwellers, rural residents had lower gastroenterology visits (HR=0.82, 95%CI 0.77–0.88) and higher 5-aminosalicylic acid (5-ASA) claims (HR=1.10, 95%CI 1.02–1.18). Furthermore, rural residents had a higher risk of IBD-specific (HR=1.23, 95%CI 1.13–1.34) and IBD-related (HR=1.20, 95%CI 1.11–1.31) hospitalizations than their urban counterparts. We did not observe significant rural-urban differences in the access to colonoscopies, biologic and immune modulator therapies, and surgeries for IBD. Conclusion We identified rural-urban disparities in IBD health care access, specifically, lower outpatient gastroenterology visits, higher 5-ASA claims, and a higher risk of hospitalizations for individuals living in rural locations at IBD diagnosis. Our findings reflect rural-urban inequities in the access to IBD care that require the attention of health care providers and decision-makers to promote health care innovation and equitable management of patients with IBD living in rural areas.

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Direct Health Care Insurer and Out-of-Pocket Expenditures of Inflammatory Bowel Disease: Evidence from a US National Survey

Digestive Diseases and Sciences ◽

10.1007/s10620-012-2289-y ◽

2012 ◽

Vol 57 (12) ◽

pp. 3080-3091 ◽

Cited By ~ 55

Author(s):

Candace Gunnarsson ◽

Jie Chen ◽

John A. Rizzo ◽

Joseph A. Ladapo ◽

Jennifer H. Lofland

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

National Survey ◽

Bowel Disease ◽

Inflammatory Bowel

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Sa512 URBAN-RURAL DIFFERENCES IN HEALTH CARE UTILIZATION FOR INFLAMMATORY BOWEL DISEASE IN THE UNITED STATES, 2017

Gastroenterology ◽

10.1016/s0016-5085(21)01968-5 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-529-S-530

Author(s):

Fang Xu ◽

Susan Carlson ◽

Kurt Greenlund

Keyword(s):

United States ◽

Health Care ◽

Inflammatory Bowel Disease ◽

Health Care Utilization ◽

Bowel Disease ◽

The United States ◽

Care Utilization ◽

Urban Rural ◽

Inflammatory Bowel

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A183 TELEHEALTH USE IN RURAL SASKATCHEWAN AND INFLAMMATORY BOWEL DISEASE OUTCOMES

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.181 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 197-199

Author(s):

M Patterson ◽

M Gozdzik ◽

J Peña-Sánchez ◽

S Fowler

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Health Care Utilization ◽

Bowel Disease ◽

Postal Code ◽

Care Utilization ◽

Specialist Care ◽

Disease Characteristics ◽

Significant Difference ◽

Inflammatory Bowel

Abstract Background Appropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient’s personal phones. Aims The objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not. Methods A retrospective chart review was completed on all rural patients (postal code S0*) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups. Results In total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups; although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p>0.05). Conclusions Prior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care. Funding Agencies None

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Health care and patients' education in a European inflammatory bowel disease inception cohort: An ECCO-EpiCom study

Journal of Crohn s and Colitis ◽

10.1016/j.crohns.2013.12.023 ◽

2014 ◽

Vol 8 (8) ◽

pp. 811-818 ◽

Cited By ~ 14

Author(s):

J. Burisch ◽

Z. Vegh ◽

N. Pedersen ◽

S. Čuković-Čavka ◽

N. Turk ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Inception Cohort ◽

Inflammatory Bowel

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Socio-anamnestic and clinical analysis of pregnant women with ulcerative colitis

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(1)-12 ◽

2021 ◽

Vol 25 (1) ◽

pp. 65-69

Author(s):

I. V. Oleksiienko

Keyword(s):

Ulcerative Colitis ◽

Health Care ◽

Inflammatory Bowel Disease ◽

Pregnant Women ◽

Bowel Disease ◽

Clinical Analysis ◽

Chronic Inflammatory Bowel Disease ◽

Care Providers ◽

History Of ◽

Inflammatory Bowel

Annotation. At the turn of the 21st century, chronic inflammatory bowel disease (CIBD) has become a global disease with accelerating morbidity in industrialized countries with a prevalence exceeding 0.3%. These data underscore the need for research into the prevention of inflammatory bowel disease and innovations in health care systems to manage this complex and costly disease. The information from a personal anamnesis of 40 women patients with ulcerative colitis (clinical group (main). In the second group (control), 30 practically healthy pregnant women with a physiological course of gestation were included, which did not have in their history of inflammatory intestinal diseases. Statistical processing of research results was performed using the software package Statistica 6.0. The arithmetic mean (M) and the standard deviation error (± m) (p<0.05) were determined, as well as the odds ratio (OR), confidence interval (CI) at p=95%. It was found that for women with ulcerative colitis is characterized by the presence of a history of obstetric pathology, such as: spontaneous miscarriage of OR 3.33, 95% CI [1.06-10.53], p=0.04 and blood secretions of OR 3.0, 95% CI [1.00-8.98], p=0.0496; among extragenital pathology in the anamnesis: children's infectious diseases of OR 4.85, 95% CI [1.25-18.85], p=0.02, chronic bronchitis of OR 7.54, 95% CI [1,56-36, 41], p=0.01, varicose veins OR 4.33, 95% CI [1.11-16.95], p=0.035, chronic gastritis OR 6.0, 95% CI [1,23-29, 31], p=0.03, anemia of OR 15.0, 95% CI [4.53-49.68], p<0.0001, allergy history of OR 6.65, 95% CI [1.73-25.60], p=0.006; among gynecological complications – premenstrual syndrome OR 6.0, 95% CI [1.55-23.15], p=0.009, algomenorrhea OR 8.14, 95% CI [2.12-31.24], p=0.002 , salpingo-oophoritis, OR 7.54, 95% CI [1.56-36.41], p=0.01. Because CIBD during pregnancy is associated with an increased risk of adverse effects on the mother and fetus, information on socio-anamnestic and clinical analysis of pregnant women with ulcerative colitis will be useful to health care providers in making decisions about CIBD during pregnancy.

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