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P665 Regional differences in health care of patients with IBD in Germany

A. Lange*1, A. Prenzler1, O. Bachmann2, R. Linder3, S. Neubauer1, J. Zeilder1, M.P. Manns2, J.-M. Graf von der Schulenburg1

1Leibniz University Hanover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany, 2Hannover Medical School, Department of Gastroenterology, Hepatology, and Endocrinology, Hannover, Germany, 3Scientific Institute of TK for Benefit and Efficiency in Health Care (WINEG), Scientific Institute of TK for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany


The regional availability of specialized physicians is an important aspect in the discussion about the healthcare of patients with IBD. Principles of the optimal healthcare were defined in the course of the development of German IBD pathways and treatment guidelines. The association between physician density and healthcare is not yet clear. Most studies did not consider district type, which reflects population density and may also have an impact on healthcare. Our research question was, "Do specialist density and district type influence the healthcare of IBD patients in Germany?"


We combined a claims dataset from a German health insurance fund with population and physician data. Four main aspects were investigated in our cohort study (derived from pathways and guidelines): regular specialist visits, drug therapies, surveillance colonoscopy, and IBD-related hospitalizations. Various regression analyses were performed.


The study cohort was comprised of 21,771 individuals, including 9,282 patients with Crohn disease and 12,489 patients with ulcerative colitis. The patients who were living in districts with higher specialist densities were more likely to attend specialist visits on a regular basis. No difference in the frequencies of TNF-alpha inhibitor therapies was found. However, individuals from urban areas were more likely to receive a permanent immunosuppressive therapy with continuous specialist support. Age, sex, and IBD type also had significant effects.


The study results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines. However, no clear evidence of a general healthcare undersupply in rural areas was found.