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Patients With IBD Receive Suboptimal Preventive Care Consultations
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LAS VEGAS — Despite existing guidelines for preventive care in patients with inflammatory bowel disease, providers fell short of expectations in consultations at a tertiary care center, according to a presenter at the Crohn’s & Colitis Congress.
“Many of our IBD patients are at higher risk of things like infections, specific malignancies, metabolic bone disease and mental health disorders not only as a product of the disease itself, but also the therapies employed. What’s important to remember about these is many of them are preventable,” Amanda Lynn, MD, a gastroenterology fellow at Mayo Clinic, Rochester, said during her presentation.
Lynn and colleagues retrospectively reviewed 150 charts of patients presenting for consultation in the IBD clinic from July 1 to December 31, 2017 and gathered information about preventative services with a focus on what was discussed with the patient, as documented in the providers’ clinic notes.
“I’ll highlight ... the fact that 85% of these patients were already on or planning on initiating some sort of immune suppressive therapy based on recommendations, highlighting the fact that this is a heavily immunosuppressed population, which requires specific preventive care measures,” she said.
Providers discussed vaccines with 45.3% of patients, with pneumococcal vaccine reviewed most frequently at 42% and herpes zoster the least at 2.1%.
“Unfortunately, less than 50% of patients had any sort of documented discussion regarding any vaccine,” Lynn said.
In looking at other preventive services, cervical cancer screening was discussed in only 15.1% of women and skin cancer prevention was reviewed with 26%. Practitioners addressed bone health in 55.4% of patients with identifiable risk factors that included postmenopausal women or those with low BMI. Thirteen patients (8.7%) were active smokers, and cessation was discussed in 46.2%.
“As we heard earlier today, this is a population in whom mental health is a great concern,” Lynn said. “In our population of 150 patients, about a third of them either had a known diagnosis of anxiety or depression or whom had indicated on their intake form some symptom that may have clued us in to them having symptoms suggestive of those diseases.”
Providers only addressed these symptoms in 10% of those patients, she said.
Lynn acknowledged that there are barriers to these discussions, such as this tertiary care center seeing many of these patients for one-time consultations focused on the refractory nature of the patients’ disease. Additionally, 87% of patients traveled more than 100 miles so providers may assume another physician handled preventive care.
“The frequency at which these preventative services were had was far less than ideal in this population,” Lynn said.
Lynn suggested possibly implementing some sort of automated electronic health record tool to give a reminder to providers and potentially patients. Additionally, a pre-visit vaccination questionnaire may help remind providers as well as create efficiencies in the visit. Lynn also suggested empowering other members of the health care team could help ensure preventive care.
“Importantly, in this population, it’s not only implementing the use of screening tools to identify mental health concerns but actually having information available for patients regarding what mental health resources are available in the community,” Lynn said. – by Katrina Altersitz
Reference: Lynn A, et al. Abstract 20. Presented at: Crohn’s & Colitis Congress; Feb. 7-9, 2019; Las Vegas.
Disclosure: Lynn reports no relevant financial disclosures.