Major Gaps In IBD Care

Main Category: Crohn's / IBD
Article Date: 26 Mar 2009 - 2:00 PDT

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The second national audit of patients with Inflammatory Bowel Disease (IBD) has found that many services for patients with IBD have improved; however, there was still wide variation in the provision of care and many services had not improved at all. Success stories include the provision of prophylactic heparin, more designated specialist ward areas and specialist nurses, and more nursing sessions, but toilet facilities and provision of psychological support still remain very poor and do not meet patients' needs.

Launched this year, the National IBD Service Standards (http://www.ibdstandards.org.uk) aim to ensure that patients with IBD receive healthcare that is safe, effective and of consistently high quality. Through the development of 6 core standards the document outlines the components of high quality care.

Inflammatory Bowel Disease affects about 1 in 250 people in the UK. The two main types of IBD are Ulcerative Colitis (UC) and Crohn's disease (CD) - different disorders, but with a considerable overlap in terms of disability and health service care. Both UC and CD commonly present in adolescence or early adulthood and cause chronic diarrhoea and abdominal pain. At least 80% of people with CD and 25% with UC require surgery at some time, usually excision of intestine or colon and sometimes with stoma formation. There are about 30,000 admissions to hospital per year with exacerbations of IBD and these are associated with some mortality and considerable morbidity. Many deaths occur around the time of surgery.

The audit is a collaborative partnership between gastroenterology physicians (the British Society of Gastroenterology), colorectal surgeons (the Association of Coloproctology of Great Britain and Ireland), patients (the National Association for Colitis and Crohn's Disease) and the Royal College of Physicians' Clinical Effectiveness and Evaluation Unit. The work of the UK IBD Audit is governed by a multidisciplinary Steering Group that includes IBD clinical nurse specialists, dietitians, pharmacists and NHS commissioners as well as representatives of the above professional and patient associations. It is funded by a grant from the Health Foundation.

The audit, which was launched today at the annual meeting of the British Society for Gastroenterology, has shown improvements in many areas of care for patients with IBD compared to the previous audit in 2006:

- More prescription of prophylactic heparin, the recommended treatment to prevent thrombosis and embolism in hospitalised patients (in ulcerative colitis 73% from 54%, in Crohn's Disease 71% from 55%)

- More designated specialist ward areas (up to 75% from 67%)

- More IBD nurses (62% from 56% of sites having a specialist IBD nurse) - 38% still do not have an IBD nurse

- More nursing sessions per week dedicated to IBD (from 6 to 8)

However, many services for patients who have IBD have not improved:

- Toilet facilities are still inadequate and do not meet patients' needs
- Dietetic services remain very poor, only one third of Crohn's Disease patients were visited by a dietitian during their hospital admission
- Psychological support for IBD patients is available in only a tenth of hospitals
- There is still an unacceptable variation in services across the UK

The improvements in services since the last audit demonstrate that the audit has been successful in raising awareness of the need to improve patient care and raise standards.

The key recommendations from the audit are:

Health Departments in England, Northern Ireland, Scotland and Wales must support future rounds of the UK IBD Audit in order that quality improvement in IBD care is sustained.
All NHS Trusts/Health Boards should review their local audit results in relation to the new IBD National Service Standards and take any necessary action to improve their IBD services.

Dr Ian Arnott, UK IBD Audit Clinical Lead, said:

The 2008 UK IBD Audit has been a great success. A participation rate of 87% of hospitals demonstrates an audit acceptable to clinicians and provides a true snapshot of services in the whole of the UK. The results show that significant improvements have been made in what is a relatively short period of time but there is clearly more work to be done. The widespread acceptance and implementation of the IBD Standards are critical to ongoing quality improvement. This, together with further rounds of the UK IBD Audit and accompanying change implementation initiatives will deliver better, more consistent and safer services for patients.

Notes

The Executive Summary of the UK IBD Audit 2nd round (2008) Report, including Key Findings and Recommendations is available via the Clinical Effectiveness & Evaluation Unit section of the Royal College of Physicians of London website.

The document Service Standards for the Healthcare of patients who have Inflammatory Bowel Disease (IBD) can be found at http://www.ibdstandards.org

The Healthcare Quality Improvement Partnership [HQIP] is committed to including IBD in the national audit programme under the continued guidance of the UK IBD Audit Steering Group subject to finalising the scope of the project.

Source
Healthcare Quality Improvement Partnership

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