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P619 Routine assessment of inflammatory bowel diseases clinical presentations: a prerequisite to check for treatment recommendations

M. Timmer1, F. Froehlich2, P. Michetti3, M. H. Maillard4, A. Schoepfer4, C. Mottet5, B. Burnand1, V. Pittet*1

1Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Lausanne, Switzerland, 2University Hospital Basel, Division of Gastroenterology & Hepatology, Basel, Switzerland, 3Clinique La Source-Beaulieu, Crohn and Colitis Centre, Lausanne, Switzerland, 4Lausanne University Hospital, Department of Gastroenterology & Hepatology, Lausanne, Switzerland, 5Hôpital Neuchâtelois, Service of Gastroenterology, Neuchâtel, Switzerland

Background

Appropriateness criteria (AC) for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC) have been developed by European experts’ panels to help clinicians for decision making. AC might be used to provide quality of care measures, namely treatments overuse. One objective behind this development is to implement AC in daily practice. A first step to check their usability was to assess the actual relevance of the clinical situations considered in panels.

Methods

Repeated cross-sectional analysis performed on adult patients included in the Swiss IBD Cohort (SIBDC), at enrolment and at first follow-up visits. Treatments AC were developed for 110 CD (87 of those were used in this study), and 54 UC detailed clinical situations (DCS), using RAND appropriateness method. Algorithms were built to routinely classify clinical situations of SIBDC patients according to those considered in panels. Extracts of a minimal set of 30 clinical variables was enough to characterise any IBD DCS.

Results

In the study, 1 427/1 604 (89%) of CD and 973/1 159(84%) of UC patients could be assigned to > = 1 DCS at enrolment (1 242/1 159(92%) of CD and 840/977(86%) of UC at first follow-up). For CD patients, the most frequent clinical situations encountered at enrolment were luminal CD in remission medically-induced +/- extraintestinal manifestations (EIM) (16.7% and 7.8%, respectively), steroid-dependent CD (5.2%), and mild-to-low-moderate luminal CD with (4.8%) or without EIM (4.3%). At first follow-up, a higher number of patients were still in medically-induced remission, but -3.8% had luminal CD without additional complications; +1.7% had EIM; +2.1% had a fistula +/- EIM; and +3.7% a stenosis +/- EIM. In total, 2 629 DCS were met by the 1426 CD patients, (94% fully documented and distributed amongst 83/87 (95%) of all CD DCS, 88% met by > = 0.5% of patients corresponding to 39/87 (45%) of CD DCS). Amongst fully documented DCS of CD in remission, 226 (52%) was obtained by steroids, 119 (27%) by biologicals mono and 73 (17%) combo therapy. The most frequent situations of UC patients were medically induced remission of left-sided (21.0%) or extensive colitis (19.6%). Moreover, 1 136 DCS were met by 984 UC patients (88% fully documented and distributed amongst 44/54 [81%] of all UC DCS, 84% met by > = 0.5% of patients corresponding to 31/54 [57%] of UC DCS).

Conclusion

Routine assessment of fully documented DCS met by IBD patients was feasible for a large majority of cases, showing that most clinical situations can be mirrored in explicit appropriateness criteria. Nearly 85% of all patients were distributed amongst half of all DCS. This leaves the possibility of checking for appropriateness of treatments for most of the patients included in SIBDC.