P627 What is the need for, and acceptability of, routine, integrated psychological care in an established inflammatory bowel disease (IBD) service? Early data from a new initiative in clinical IBD care
T. Lores*1, C. Goess1, R. Grafton1, J. Hughes1, L. Cronin1, A. Mikocka-Walus2, A. Chur-Hansen3, A. Burke4, K. Collins4, J. Andrews1
1Royal Adelaide Hospital, Gastroenterology, Adelaide, Australia, 2University of York, Heslington, United Kingdom, 3University of Adelaide, Adelaide, Australia, 4Royal Adelaide Hospital, Psychology, Adelaide, Australia
Psychological issues are known to be prevalent in people with inflammatory bowel disease (IBD), and are risk factors for poor outcomes including hospitalisation, low medication adherence, and persistent smoking. Psychological care, however, is not routinely provided to people with IBD. The aim of this study is to explore the potential benefit of psychological assessment and targeted therapy in IBD patients in the routine care environment. Here we report on the initial data around the need for, and acceptability of, this approach.
In a prospective cross-sectional design, participants are recruited by e-mail, via post and in-person at scheduled outpatient appointments. Potential participants are drawn from the approximately 1 200 IBD patients at the Royal Adelaide Hospital. Screening data are gathered by questionnaire, and psychological therapy offered where scores indicate likely need. Potential participants are provided with study information and completion of questionnaires signifies consent. Mental health is measured using the Hospital Anxiety and Depression Scale (HADS) and the Kessler 6 Scale (K6), medication adherence by the Morisky Medication Adherence Scale (MMAS-8), and quality of life by the Assessment of Quality of Life measure (AQoL-8D).
To date, 128 patients have been approached, with 87 (68%) participating. Further, 40 (46%) patients scored within the clinical range on at least 1 subscale of the HADS or K6, with 23 (58%) accepting a discussion with the on-site psychologist. In addition, 19 (48% of those with clinical results) subsequently accepted psychological support. The screening process has been easy to implement, with positive feedback from patients and staff. Of the 19 patients accepting psychological support, mean age is 40.8 years (range 20–58); 53% are female, and mean disease duration is 11.9 years (range 1–32). Further, 15 (79%) have Crohn’s disease; 3 (16%) have ulcerative colitis; 1 (5%) IBD-unspecified; and 8 (42%) had active disease at the time of screening. In addition, 10 (53%) are on multiple IBD medications (including 53% on biologics and 63% on immuno-suppressants); 5 (26%) on pain medications; and 4 (21%) on psychiatric medications. Mean HADS anxiety score is 13 (moderate), and mean depression score is 11 (moderate).
Initial data support the need for, and acceptability of, psychological care in an established IBD service. Psychological screening has been easy to implement, is well accepted, and it uncovers a high need for psychological support in the routine care setting. Longer-term outcomes will inform of potential mental or physical health benefits from this approach.