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P539 Impact of a multi-disciplinary team meeting for managing inflammatory bowel disease patients: professional practice analysis based on 869 cases

H. Del Arco1, P. Rivière1, F. Zerbib1, D. Laharie1, F. Poullenot1

1Bordeaux University Hospital, Gastroenterology and nutrition, Bordeaux, France

Background

Multi-disciplinary team (MDT) meetings have been implemented in several inflammatory bowel disease (IBD) referral centres within the last years. In our regional IBD centre, a monthly MDT meeting exists since 2001. Our objective was to realise a critical analyse of a tertiary referral centre IBD-MDT meeting through a professional practice evaluation (PPE).

Methods

Three steps were defined for the PPE of the IBD-MDT meeting. Firstly, all cases discussed from January 2014 to December 2017 were retrospectively retrieved for a practice enquiry with indicator. The chosen indicator was whether the MDT meeting decision had been applied or not. Secondly, an audit was realised through 2 video-recorded MDT meeting, critically analysed to draw area for improvement. Finally, a satisfaction questionnaire was distributed to gastroenterologists during a regional post-graduate meeting.

Results

For the practice enquiry, among the 1163 cases discussed during the 4-year period, 335 were excluded by lack of information about patients' outcome and 4 due to missing referent gastroenterologist's name; 863 IBD cases could be analysed (median age 38 years, 50% female). The MDT meeting decision was applied in 72% of cases, not applied in 16% of cases, no clear information found in medical report in 11% of cases. In multi-variate analysis, for patients with Crohn’s disease, the workplace of the referring physician was associated with a poorer follow-up of the decision (p = 0.02 for global factor, private centres vs. university hospital; OR: 3.3 (95% CI) 0.9–11.3)). In patients with ulcerative colitis, patient's female gender was related to a poorer follow-up of the decision (OR: 5.7 (95% CI, 1.8–19.5); p < 0.01). Between March and May 2018, 45 case discussions have been video -recorded. Median (interquartile range) duration of case discussion was 5.0 (3.0–5.6) min; the referent gastroenterologist was absent in 58% of cases; a reinterpretation of medical imaging was needed in 53% of cases. The more frequent incident was telephone ringing during the MDT meeting (22% of discussions impacted). Finally, 23 gastroenterologists answered the satisfaction questionnaire. For all of them, the IBD-MDT meeting was considered helpful for patients’ management. Practical modalities of the MDT were known by 91% of participants but several modifications were suggested regarding the timing of the meeting or the availability of a videoconference system.

Conclusion

Rate of IBD-MDT meeting decision followed is high but could be improved. This PPE led to several proposals of improvement. IBD-MDT will soon be essential regarding the growing number of therapeutic options and drug costs. National and international organisations guidelines could help to structure these meetings.