P490 Clinicians’ adherence to European Crohn’s and Colitis Organisation guidelines in the clinical care of adults with inflammatory bowel disease
B. Jackson*, D. Con, P. De Cruz
Austin Health, Gastroenterology, Melbourne, Australia
Although evidence-based guidelines have been developed for inflammatory bowel disease (IBD), the extent to which they are followed is unclear. A potential barrier to quality of care in IBD is a lack of evidence-based practice. The objective of this study was to review clinicians’ adherence to international IBD guidelines.
Retrospective data collection of all patients who attended a tertiary hospital IBD clinic from April 2014 to March 2015. Management practices were audited and compared with current European Crohn’s and Colitis Organisation (ECCO) guidelines.
Data from 288 patients were collected and analysed: 47% (136/288) were male; mean age 43 (range 18–86); 140/288 (49%) patients had ulcerative colitis (UC); 145/288 (50%) patients had Crohn’s disease (CD), and; 3/288 (1%) patients had IBD-unclassified (IBD-U). Patient care was undertaken by: 5 public gastroenterologists, several private gastroenterologists, 9 gastroenterology trainees, and several general practitioners. Disease Management: Overall adherence to disease management guidelines occurred in 204/288 (71%) of patient encounters in the IBD clinic. Discrepancies between guidelines and management were found in 25/80 (31%) of patients with UC in remission receiving oral 5-aminosalicyclates (5-ASAs) as maintenance therapy, and 46/110 (42%) of patients with small bowel and/or ileo-caecal CD receiving 5-ASA. Psychological care: Assessment of psychological well-being was undertaken in only 16/288 (6%) of patients. Preventive Care: colonoscopic re-evaluation including dysplasia surveillance was undertaken in 41/43 (95%) patients with left-sided or extensive UC and in 8/8 (100%) patients with Crohn’s colitis for ≥ 8 years. Adherence to ≥ 1 additional component of preventive care was observed in only 73/288 (25%) of patient encounters: 12/133 (9%) on thiopurines underwent annual skin checks for non-melanoma skin cancer; 61/288 (21%) of patients with IBD underwent a DEXA bone scan; 46/288 (16%) patients were reminded to have their influenza vaccine; and 29/36 (81%) patients who were smoking were offered advice regarding smoking cessation.
There remains a gap between adherence to evidence-based ECCO guidelines and clinical practice. These data reflect that the focus of outpatient care is on disease management with variable adherence to guidelines in the use and dosing of 5-ASAs for small bowel CD and maintenance therapy for UC. Psychological and preventive care aspects of chronic disease management are often neglected. Standardising practice using evidence-based clinical pathways may be a strategy towards improving the quality of IBD outpatient management.