IBD audit reveals shocking level of care across Australia

Just one percent of public hospitals meet the minimum standards for IBD care, a preliminary report into the quality of IBD care in Australia reveals.

However the few Australian hospitals that did meet these standards had better patient outcomes compared to centres that fell short of the criteria agreed by the professional bodies.

The sneak peek of data from the audit of 71 IBD centres was delivered by Dr Greg Moore, Head of IBD at Monash Health and a board member of Crohn’s and Colitis Australia at AGW 2016 held in Adelaide last week.

He said the goal of the audit was to improve the quality and safety of care for all IBD patients and provide government with an evidence-based case for increased IBD resources.

Overall, IBD centres were deemed to have met minimum standards if they had a gastroenterologist and a colorectal surgeon with IBD training, IBD nurse support with a telephone helpline, access to a dietitian, psychologist or counsellor, stomal therapist, and a radiologist and histopathologist with an interest in IBD.

Less than a quarter of hospitals in the audit were considered to have a partial IBD service – defined as having 0.4 EFT IBD nurse, a named clinical lead and an IBD helpline.

Of the remaining centres 39% had an IBD nurse and 38 percent had a gastroenterology team made up of a gastroenterologist, colorectal surgeon, dietitian and stomal nurse.

Failing IBD patients

The audit, delivered as part of the ongoing IBD quality care program, captured almost a third of the 5460 people admitted with IBD as a principal diagnosis.

It revealed that the vast majority of patients admitted to hospitals were young – 60% were aged under 40 and 10 percent were in the paediatric age range of 0-18 years.

“There’s clearly a significant burden of health and morbidity affecting predominantly young people in the most productive times of their lives,” Dr Moore told delegates.

The fact that over half of the patients had been diagnosed over five years prior to their admission also highlighted a failure to bring disease under control.

Other key findings from the audit included high rates of anaemia (one-third of patients), malnutrition and psychological co-morbidities.

Furthermore, over 20% of patients with Crohn’s disease required surgery and 17% of ulcerative colitis patients needed a colectomy.

The audit showed that only 28% of the sites had a protocol to manage acute severe ulcerative colitis.

Less than 20% of patients saw an IBD nurse, and those that did have an IBD nurse were often too busy managing the outpatient clinics to be able to see patients admitted to the hospital.

Over half of patients were discharged on immunosuppressant drugs but only two-thirds had any form of safety monitoring put in place.

And less than half of patients had a nutritional risk assessment undertaken or saw a dietitian and only 9% of those taking long-term steroids had bone densitometry testing.

Disappointing but not surprising

Speaking to the limbic after the conference, Dr Moore said it was disappointing, but not surprising to see such a poor performance considering the lack of adequate funding for IBD services.

“We know that treating patients earlier leads to better outcomes, and we know that properly resourced IBD services make a huge impact,” he said. “Even the most basic facilities saw decreased hospital admissions.”

He said the evidence was hard to ignore, from both clinical and financial perspectives, and he hoped it would pave the way for funding that would allow the organisation and delivery of more services for patients.

“I think the recognition that even the units with minimal presence had an impact on the reduction of presentations to hospitals should speak for itself,” he said. “These units have the potential to be cost-saving as well as providing excellent quality of care to patients.”

IBD services had better outcomes

However, it wasn’t all doom and gloom as hospitals that did have an IBD service, even if minimal,  did have better outcomes, Dr Moore told delegates.

“This is the headline result for government: if you have an IBD service you have a 15-17% reduction in admissions via emergency departments,” he said.

The audit did not reveal any differences in length of stay between hospitals that met minimum standards and those that didn’t.

However, those that met the minimum standard had improved safety monitoring for patients on immunosuppressive therapy, higher rates of laparoscopic surgery and fewer patients receiving unnecessary radiation.

IBD centres that met the minimum standards also had higher rates of patients on biologics and patients had better access to clinical trials.

The NAPLAN of IBD services

The final report will be published in November but Dr Moore told conference delegates it wouldn’t end there.

There will be a further analysis as well as individual site reports and benchmarks.

“It’s what I like to think of as a NAPLAN for your IBD service but you’ll be matched against like for like,” he said.

The next stage of the audit will also include the perspective of patients and their experiences, he added.

The IBD quality of Care Program is funded by the Australian Government Department of Health, Crohn’s & Colitis Australia, and supported by an educational grant from Janssen (Janssen-Cilag Pty Ltd) and funding from Ferring Pharmaceuticals.

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