P559 Improving Health Care of Patients with Inflammatory Bowel Diseases (IBD) by Fostering Networking of Physicians - it´s not that easy!
B. Bokemeyer*1, J. Langbrandtner2, P. Jessen3, J. Büning4, S. Schreiber5, H. Raspe2, A. Hüppe2
1Gastroenterology Practice Minden, University Hospital Schleswig-Holstein, Department of General Internal Medicine I, Kiel, Germany, Minden, Germany, 2Universität zu Lübeck, Institut für Sozialmedizin und Epidemiologie, Lübeck, Germany, 3Gastroenterology Practice, Gastroenterology, Altenholz, Germany, 4University Hospital Schleswig-Holstein, Campus Lübeck, Medical Department I, Gastroenterology, Lübeck, Germany, 5Christian-Albrechts-Universität, University Hospital Schleswig-Holstein, Department of General Internal Medicine I, Kiel, Germany
IBD-patients (pts) suffer from a wide range of somatic and psychosocial problems. They are in need of comprehensive, interdisciplinary and cross-sectoral health care. In- and outpatient gastroenterologists in a region of Northern Germany tried to optimize their quality of care by network activities. The impact on patient related outcomes (PROs) was evaluated. We report the 6-months interim analysis of this 12-months prospective study.
In the beginning of 2014 349 outpatients with IBD were included in a prospective controlled cohort study. 15 gastroenterologists included 189 pts in the intervention-region (IG: intervention group) and another 18 gastroenterologists from the rest of Germany included 160 pts in the control group (CG). At baseline, 6 and 12 months pts completed a questionnaire assessing 22 somatic and psychosocial problems, medical data on the course of the disease were gathered by the gastroenterologists. Primary outcomes were health related quality of life (HRQoL: EQ-VAS) and social participation restrictions (IMET), secondary outcomes were disease activity (GIBDI) and work productivity (WPAI). Pts in the intervention group (IG) promptly received written feedback of their problem-profile together with individualized recommendations for appropriate treatment. Further interventions in the IG were the introduction of interdisciplinary IBD-case conferences and the offer of a patient training in small groups.
310 (IG: 160; CG: 150) of 349 IBD-pts (UC: 47.6%; CD: 52.4%) participated in the 6-months follow-up. Baseline characteristics were broadly similar (age: 43 years; 60% female; 63% in remission; 67% in full- or part time employment). Only minor differences between IG and CG for age, school education and medication could be found. No significant differences between IG and CG were seen at 6-months follow-up with respect to the primary outcomes: neither for HRQoL (EQ-VAS: changes from 73.3 to 74.2 in IG; from 70.6 to 72.7 in CG; p=0.267) nor for social participation restrictions or further secondary outcomes. In contrast, the feedback of the physicians in the IG were more favorable at the 6-months follow-up. 67% of the physicians participated in IBD-case conferences, the benefit of networking has been ranked with 7 on a scale from 0 (no benefit) - 10 (best benefit).
The 6-months interim analysis could not show any significant improvements in the primary outcome parameters (HRQoL and IMET) in the IG vs. CG. Nevertheless, the participating physicians described clearly positive effects for their daily work. We are looking forward to the 12-months follow up, hoping for beneficial effects in the patient´s experience in the long run, too.