IBD patients and healthcare utilisation: gastroenterologists do make a difference!

Abstract

Introduction Inflammatory bowel diseases (IBD) (predominantly Crohn’s disease (CD) and ulcerative colitis (UC)) are chronic diseases with significant consequences for healthcare utilisation and resource allocation. We aim to examine local healthcare utilisation in IBD patients compared with matched controls. Methods All patients with a coded diagnosis of IBD were prospectively identified from encounters at a single large metropolitan institution in a five month period. From this group of IBD patients, those with one or more hospital admissions in a 15-month time frame were selected. Age and gender matched controls (5 per IBD case) were randomly selected from the same 15-month period for comparison of total length of stay (TLOS) and number of admissions. Patient case notes were examined to confirm IBD diagnosis, disease severity and complications. Mann–Whitney U and t-tests were used for statistical comparisons. Results 233 IBD patients were identified, of these 102 (43.7%) had at least one inpatient admission from 1/1/2007 to 31/3/2008. These 102 were matched to 510 controls. A greater proportion IBD patients had CD than UC (69 vs 30; P = 0.04). Those aged <30 years were more likely to have CD (n = 25) than UC (n = 4) compared with those aged over 60 years (CD n = 12, UC n = 13, P = 0.004). Mean number of admissions and TLOS were significantly lower in IBD patients seen prior to admission by a gastroenterologist (P = 0.004, P = 0.01, respectively). There was also a trend suggesting those admitted for bowel resection during the study period were less likely to have prior care from a gastroenterologist (P = 0.09). Compared with controls, IBD patients had more admissions (mean 1.72 vs 1.55, P = 0.002) and longer TLOS (median 6.8 vs 3.4 days, P < 0.0001) as did both CD (admissions 1.62 vs 1.51, P = 0.032, LOS 6.0 vs 3.1 days, P < 0.0001) and UC (admissions 1.93 vs 1.64, LOS 8.3 vs 3.9 days) when examined separately. Conclusions IBD patients have significantly increased inpatient healthcare utilisation compared with matched controls. Prior specialist care may reduce admission rates, TLOS and possibly rates of bowel surgery. Thus resources should be apportioned to ensure IBD patients have easy access to care from gastroenterologists in order to improve patient outcomes. This may additionally provide overall healthcare savings.