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P201 Evaluating access to inflammatory bowel disease care across Canada: Proceedings from the 2017 IBD Access Summit

S. MacDonald1, C.G. Heisler2, H. Mathias3, R. Mirza4, J. Jones1

1Department of Medicine, Dalhousie University, Halifax, Canada, 2Department of Digestive Care and Endoscopy, Nova Scotia Health Authority, Halifax, Canada, 3School of Health and Human Performance, Dalhousie University, Halifax, Canada, 4Department of Social Work, University of Toronto, Toronto, Canada

Background

Inflammatory bowel disease (IBD) is a chronic, immune-mediated disease, with Canada demonstrating the highest incidence and prevalence rates in the world. Patients with IBD often require lifelong treatment and, therefore, lifelong interactions with the healthcare system. Access to care can have a direct impact on patient health-related outcomes. Although acknowledged as a problem, the complexity of accessing IBD speciality care in Canada has not been reviewed. This lack of understanding presents a barrier in evaluating and implementing changes in IBD speciality care. The aim of the project was to identify key barriers and facilitators for and to develop a national working strategy to address limitations in access to IBD speciality care.

Methods

The IBD Summit was held in Toronto, Ontario in November 2017, sponsored by SPOR-CIHR catalyst funding and in partnership with Crohn’s and Colitis Canada. Perceptions and experiences of key stakeholders were gathered during two audio-recorded stakeholder dialogues held during the Summit. The audio recordings were transcribed and coded to compare and contrast between key stakeholders to determine potential differences in access to IBD care. Five final themes are highlighted in this report.

Results

A total of 21 key stakeholders attended, including paediatric and adult gastroenterologists, patients, researchers, and policymakers. Five key themes of importance relating to access to IBD care arose from The IBD Summit:(1) Integrated Models of Care, (2) IT Enhanced Care, (3) Health System Process, (4) Communication and Advocacy, and (5) Community Supports. The IBD Summit identified similar perceptions and experiences, highlighting common barriers and facilitators that transcend provincial borders. Shared perceptions included a need for common medical records and overall improved IT-enhanced care for managing IBD; improved centralised triage systems; increased comprehensive care support for patients and primary care physicians; and increased community supports for patients and providers.

Conclusion

Highlights from the IBD Summit present several clinically relevant and actionable suggestions for improved access to IBD speciality care across Canada. The suggestions provided by key stakeholders highlight the need for a system-level redesign in order to improve access to enhanced models of care. Improvements in access to IBD speciality care can only occur through partnerships between those working within the healthcare system and those within the community. Future research will involve pursuing deeper insight into the experience of patient and provider stakeholders as they navigate the healthcare system in order to access and provide care.