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P143 Quality in inflammatory bowel disease care: measure, educate, and improve—a real-life survey

C. Viganò*1, G. Meucci2, S. Saibeni3, C. C. Cortelezzi4, A. Amato5

1Ospedale San Gerardo, UOC Gastroenterologia, Monza, Italy, 2Ospedale San Giuseppe, Unità di Gastroenterologia ed Endoscopia Digestiva, Milano, Italy, 3Ospedale di Rho A.O. Guido Salvini, UO Gastroenterologia, Rho, Italy, 4AOU di Circolo Fondazione Macchi, UO Gastroenterologia ed Endoscopia Digestiva, Varese, Italy, 5Ospedale Valduce, UOC Gastroenterologia, Como, Italy

Background

Management of inflammatory bowel disease (IBD) patients is subject to wide variability; this has been reported to be associated with poor clinical outcomes in many diseases. Guidelines help to deal with this issue; however, lack of adherence to guidelines has been reported even in tertiary care IBD centres. Quality process indicators have been identified for IBD care. Preliminary evidence suggests that implementation of quality indicators in a quality improvement process could change practice and improve quality of care in patients with IBD. The aim of this study was to assess adherence of physicians to guidelines and the possibility to improve it.

Methods

A survey was carried out amongst members of a regional study group on IBD, by means of a 10-item questionnaire. Physicians were asked to answer multiple-choice questions concerning relevant quality process indicators for IBD care according to their real practice. Afterwards, they attended a conference during which dedicated informative material was shown and subsequently also e-mailed. After a 6-month period, the questionnaire was resubmitted for evaluation of variation in reported practice.

Results

The questionnaire return rate was 38% (50/132) for the first round and 30% (40/132) for second round. At first round, 67% of physicians reported a regular yearly addressing of cigarette smoking; 98% performed tuberculosis screening before anti-tumour necrosis factor therapies; 22% suggested screening for HBV serological status at IBD diagnosis, and 47% recommended vaccination in non-immune IBD patients. None of these items had changed significantly at second round.

Further, at first round, 92% of physicians reported prescribing endoscopic colorectal cancer screening to patients with extensive colitis starting 8–10 years from diagnosis; only 70% of them prescribed yearly colonoscopy for patients with concomitant primary sclerosing cholangitis, and this figure significantly increased to 87% (p < 0.05) at second round. Moreover, Clostridium difficile infection assessment at diarrhoea reactivation increased from 48% to 88% at second round (p < 0.01). Influenza and pneumococcal vaccination in immunocompromised patients was suggested by 29% and 58% of physicians, at first and second round, respectively (p < 0.01). Similarly only 34% of participants prescribed Pneumocystis Jirovecii chemoprophylaxis for patients on triple immunosuppressive regimen, and this increased to 58% (p < 0.01) at second round.

Conclusion

This survey depicts limited self-reported adherence to quality indicators by physicians treating IBD patients, especially concerning infectious disease preventive practices; this attitude appears to be at least partially amendable through implementation of educational programmes. Quality programmes need to be set up also in IBD care.

References:

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[2] Feuerstein JD, Castillo NE, Siddique SS, et al. Poor documentation of inflammatory bowel disease quality measures in academic, community and private practice. Clin Gastroenterol Hepatol 2015 Oct 20. pii: S1542-3565 (15)01418-4; epub ahead of print.

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[4] Melmed GY, Siegel CA, Spiegel BM, et al. Quality indicators for inflammatory bowel disease: development of process and outcome measures. Inflamm Bowel Dis 2013;19:662–68.

[5] American Gastroenterological Association AGA. Physician Quality Reporting System (PQRS) Implementation guide for registry-based reporting for the Inflammatory Bowel Disease (IBD) Measures Group 2015. http://www.gastro.org/practice-management/quality/2015_AGA_Measures_-_IBD.pdf.

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[7] Crandall WV, Margolis PA, Kappelman MD, et al. Improved outcomes in a quality improvement collaborative for paediatric inflammatory bowel disease. Paediatrics 2012;129: e1030–41.

[8] Christensen KR, Steenholdt C, Buhl SS, et al. Systematic information to health-care professionals about vaccination guidelines improves adherence in patients with inflammatory bowel disease in antiTNFα therapy. Am J Gastroenterol 2015;110:1526–32.