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DOP37 Large differences in IBD care and education across Europe, first results of the pan-European VIPER survey

Král, J.(1);Nakov, R.(2);Lanska, V.(3);Barberio, B.(4);Benech, N.(5);Blesl, A.(6);Brunet, E.(7);Capela, T.L.(8);Derikx, L.A.A.P.(9);Dragoni, G.(10);Eek, A.(11);Frias-Gomes , C.(12);Gîlcă-Blanariu , G.E.(13);Gilroy, L.(14);Harvey, P.R.(15);Kagramanova, A.(16);Kani, H.T.(17);Konikoff, T.(18);Lessing, M.(19);Madsen, G.R.(20);Maksimaityte, V.(21);Miasnikova, M.(22);Mikolasevic, I.(23);Milivojevic, V.(24);Noviello, D.(25);Oliinyk, D.(26);Patai, A.(27);Protopapas, A.A.(28);Rodríguez-Lago, I.(29);Schreiber, P.(30);Skuja, V.(31);Tran, F.(19);Truyens, M.(32);Włodarczyk, M.(33);Zatorski, H.(34);Verstockt, B.(35);Segal, J.P.(36)

(1)Institute for Clinical and Experimental Medicine, Department of Hepatogastroenterology, Prague, Czech Republic;(2)Tsaritsa Yoanna University Hospital- Medical University of Sofia, Department of Gastroenterology, Sofia, Bulgaria;(3)Institute for Clinical and Experimental Medicine, IT Department, Prague, Czech Republic;(4)Gastroenterology Unit- University of Padova-Azienda Ospedaliera di Padova, Department of Surgery- Oncology and Gastroenterology DISCOG, Padova, Italy;(5)Saint Antoine Hospital- AP-HP, Department of Gastroenterology, Paris, France;(6)Medical University of Graz, Department of Internal Medicine- Division of Gastroenterology and Hepatology, Graz, Austria;(7)Hospital Parc Tauli, Department of Gastroenterology, Sabadell, Spain;(8)Hospital Senhora da Oliveira, Gastroenterology Department, Guimarães, Portugal;(9)Inflammatory Bowel Disease Center- Radboud University Medical Center, Department of Gastroenterology and Hepatology, Nijmegen, The Netherlands;(10)IBD Referral Center- Careggi University Hospital, Department of Gastroenterology, Florence, Italy;(11)Tartu University hospital, Department of Gastroenterology, Tartu, Estonia;(12)Hospital Beatriz Ângelo, Gastroenterology division- Surgery department, Loures, Portugal;(13)Grigore T Popa University of Medicine and Pharmacy, Gastroenterology Department, Lași, Romania;(14)Royal Victoria Hospital, Department of Gastroenterology, Belfast, United Kingdom;(15)Harvey PR- Russells Hall Hospital, Department of Gastroenterology, Dudley, United Kingdom;(16)Moscow Clinical Scientific Centre n.a. A.S. Loginov, IBD department, Moscow, Russian Federation;(17)Marmara University- School of Medicine, Department of Gastroenterology, Istanbul, Turkey;(18)Rabin Medical Center- Sackler Faculty of Medicine, Division of Gastroenterology, Tel-Aviv, Israel;(19)University Medical Center Schleswig-Holstein, Department of Internal Medicine I, Kiel, Germany;(20)Copenhagen University Hospital Hvidovre, Gastrounit, Copenhagen, Denmark;(21)Institute of Clinical Medicine- Faculty of Medicine- Vilnius University, Clinic of Gastroenterology- Nephrology- and Surgery, Vilnius, Lithuania;(22)Medical Center Medeor, Out-patient department, Chelyabinsk, Russian Federation;(23)UHC Rijeka and UH Merkur, Department of Gastroenterology, Rijeka, Croatia;(24)Clinical center of Serbia- School of medicine, Clinic for gastroenterology and hepatology, Belgrade, Serbia;(25)University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy;(26)Bogomolets National Medical University, Department of surgery №1, Kyiv, Ukraine;(27)Semmelweis University, Department of Internal Medicine and Hematology, Budapest, Hungary;(28)Aristotle University of Thessaloniki- AHEPA Hospital, First Propedeutic Department of Internal Medicine, Thessaloniki, Greece;(29)Hospital de Galdakao, Department of Gastroenterology, Galdakao, Spain;(30)University Hospital Zurich, Department of Gastroenterology & Hepatology, Zurich, Switzerland;(31)Riga Stradins University, Gastroenterology- Hepatology and Nutrition Clinic, Riga, Latvia;(32)Ghent University, Department of Internal Medicine and Pediatrics, Ghent, Belgium;(33)Faculty of Medicine- Medical University of Lodz, Department of General and Colorectal Surgery- Department of Biochemistry, Lodz, Poland;(34)Faculty of Medicine- Medical University of Lodz, Department of Digestive Tract Diseases, Lodz, Poland;(35)University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium;(36)Hillingdon Hospital, Department of Gastroenterology, Uxbridge, United Kingdom

Background

More than 2.5 million people in Europe suffer from inflammatory bowel diseases (IBD). IBD affects the quality of life, but also has important consequences for health systems. As IBD care and education might differ and might be linked to Gross Domestic Product (GDP), we conducted this European Variation In ibd PracticE suRvey (VIPER) to study potential differences.

Methods

This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Differences between groups were calculated using the chi2 statistic.

Results

The online survey was completed by 1268 participants from 39 European countries (Figure 1). Most of the participants are specialists (65.3 %), followed by fellows in training (>/< 3 years, 19.1%, 15.6 %). Majority of the responders are working in academic institutions (50.4 %), others in public/district hospitals (33.3 %) or private practices (16.3 %).

Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p<0.001), majority of clinicians feels comfortable in treating IBD (77.2% vs 72.0%, p=0.04). Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p<0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p<0.001), which often take place on a weekly basis (53.0%) (Figure 2). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p<0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p<0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p<0.001).

In the current COVID era, telemedicine is available in 58.4% vs 21.4% of the high/low GDP countries respectively (p<0.001), as well as urgent flare clinics (58.6% vs 38.7%, p<0.001) and endoscopy within 24 hours if needed (83.0% vs 86.7% p=0.1). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly (Figure 3). Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%).





Conclusion

A lot of variability in IBD practice exists across Europe, with marked differences between high vs low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardise IBD care across Europe.

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