P370 Treatment patterns in a managed care project with inflammatory bowel disease patients in Germany: CEDnetz study
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 experience various somatic and psychosocial impairments. They need comprehensive, interdisciplinary, and problem-oriented health care. To improve their quality of health care, IBD-pathways recommend a systematic assessment of health-related problems and focus on a multidisciplinary, patient-centred care. In a prospective controlled cohort study, German gastroenterologists tried to optimise their quality of care by network activities.
In a region of North Germany, 15 gastroenterologists recruited outpatients with IBD (intervention group [IG]), outside this region; 18 gastroenterologists included nationwide IBD patients in a control group (CG). At baseline (t0), 6 (t1), and 12 months (t2), patients completed a questionnaire assessing 22 somatic and psychosocial problems (patient-reported outcomes), and the attending physicians documented clinical data and medication. IG-patients received written feedback of their problem-profile together with individualised recommendations for appropriate treatment. Further IG-interventions were the implementation of interdisciplinary IBD-case conferences and the offer of a group-based patient-education programme.
In the study, 282 of 349 IBD patients (80.8%; IG 142 of 189; CG 140 of 160) participated in both follow-up visits. Baseline characteristics were broadly similar (age 43 yr; 61% female; 50% with CD; 66% in remission). At baseline on the one side immunosuppressants were more often used in the CG (UC 48%; CD 50%) than in the IG (UC 32%; CD 26%), on the other side, anti-TNFs were used more frequently in the IG (UC 17%; CD 56%) than in the CG (UC 13%; CD 27%). The 12-months course showed a more frequent guideline-based therapy with reduced steroids in the IG (8% vs 20%; p = 0.013), and we observed a fairly similar steroid prescribing habit in the IG (22% vs 20%). In CD anti-TNFs remained unchanged in the IG after 12 months (56% vs 58%), and reduced prescription rates for anti-TNFs were identified in the CG (27% vs 19%). In UC anti-TNFs increased during the 12 months course in the IG (17% vs 35%). In contrast, we found a stable anti-TNF level with 13% over the time in the CG.
Our complex intervention could not be proved as effective and beneficial in the primary outcomes (health-related quality of life and social participation restrictions). However, in the secondary outcomes (steroid use and treatment patterns), we found an advantage for the IG. Steroid use was reduced by more than 50%. The missing efficacy in the primary outcomes could be partially explained by the fact, that not all network activities in the IG could have been realised in the aimed frequency. Further (sub-group) analysis will promote the discussion.