N012 Audit into oral steroid usage in inflammatory bowel disease patients
G. Lloyd-Ford*, A. Lewis, L. Hook
Aneurin Bevan University Health Board, Gastroenterology, Newport, United Kingdom
It was identified that patients with flare ups of their inflammatory bowel disease (IBD) were receiving repeated doses of oral steroids to control their symptoms. Some of the prescriptions had been given in Secondary Care by the IBD Team; however, there was a suggestion that many prescriptions were being issued in Primary Care without informing the IBD Team. Repeated steroid use can have side effects but can also be an indication of the need to step up a patient’s therapy. The aim of this audit was to see how often patients were having steroids to control their IBD symptoms, but also to see what their perception of steroid use was.
A simple questionnaire was devised and given to patients seen in the outpatients department. A total of 100 questionnaires were given out. They were anonymous and the data collected was interpreted by the IBD Nursing Team in a table, graph, and numerical representation. As this is an audit, no ethical approval was required.
Of the 100 questionnaires given out, 67 were returned. Of those returned, 63% (n = 42) had ulcerative colitis, 37% (n = 25) had Crohn’s disease, and no one had IBD indeterminate. Maintenance medication was reported as 15% (n = 10) received no regular treatment; 31% (n = 21) received 5ASA; 51% (n = 34) received thiopurine immunomodulation; and 3% (n = 2) received anti-TNF. Further, 85% (n = 57) of the patients felt that steroids helped, although which steroid was prescribed was not looked at during this audit. Of those patients who had received oral treatments, 73% (n = 49) had received more than 1 course in a 12 month period. General practice prescribed 77% (n = 51) of the prescriptions, and Secondary Care (IBD nurse or consultant) prescribed 23% (n = 15). When asked why they used steroids, the majority of patients (88%, n = 59), suggested that they felt it gave them rapid return to quality of life; however, remission and recurrence of symptoms was common place (79%, n = 53).
It is no real surprise to any clinician working in IBD care to see that patients often rely on steroids as a quick fix solution to a normal life. The concern from the results is that patients are in the community with uncontrolled disease, increasing the risk of complication and side effects of IBD, including risk of cancer and the need for emergency surgery, along with steroid-dependent conditions. By using Primary Care services, patients may be missing out on the specialist advice that the IBD team can provide, helping to better control both symptoms of disease and risk of complications.