Abstract
Purpose
There is a growing evidence for over-, under-, or misuse of health care in patients with inflammatory bowel disease. Most studies looked at treatment variability or used quality measures, which mostly capture supportive interventions rather than treatment of IBD in itself. We aimed to evaluate if current recommendations in clinical practice guidelines regarding the medical treatment of patients with inflammatory bowel diseases are being followed in Germany.
Methods
A questionnaire was sent to 1901 patients insured with two large German statutory sickness funds and an ICD 10 diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC). The questionnaire asked about drug treatment, indications for drug treatment, provision of surveillance endoscopies in ulcerative colitis patients, and smoking status in Crohn’s disease patients.
Results
Out of 460 evaluable patients, 62.4% of UC patients and 53.9% of CD patients were treated with mesalamine according to guidelines, 91.3% of all patients were treated with glucocorticoids according to guideline recommendations, while only 75.6% received recommended immunosuppressive treatment. Of UC patients, 94.5% had surveillance colonoscopies at the recommended interval and 58.8% of CD patients were non-smokers. No predictor for overall treatment according to guidelines could be found while being of age older than 60 or being treated outside of a dedicated IBD clinic was associated with less immunosuppressive treatment.
Conclusions
A large proportion of patients with IBD do not receive drug treatment in accordance with clinical practice guidelines. Quality improvement measures are much needed.
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Acknowledgments
We would like to acknowledge the support by the three involved sickness funds, AOK Nordost (Katrin Peise), TK (Christine Vietor), and AOK Rheinland/Hamburg (Markus Feger) as well as Annegret Schönberg for secretarial assistance.
Funding agency
This study was partially funded by the Ministry of Education and Research (Bundesministerium für Bildung und Forschung), Germany, through the Kompetenznetz Entzündliche Darmerkrankungen (Grant Number 01 GI 0486).
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JCH served as consultant for Astra, Falk, Hexal, Janssen, Pfizer, Steigerwald, and Takeda, and received lecture fees from Falk, Janssen, MSD, Pfizer, and Takeda. BS received a research grant from Pfizer, served as consultant for Falk, Janssen, MSD, Abbvie, Celgene, Lilly, Takeda, Pfizer, and Hospira and received lecture fees from Abbvie, Falk, Ferring, Janssen, MSD, Merck, and Takeda; all money went to the Charité-Universitätsmedizin Berlin, Germany. JCP served as a consultant for MSD, Pfizer, Takeda, and Biogen and received lecture fees from Vifor, Falk, Janssen, Abbvie, Pfizer, Vifor, MSD, and Takeda.
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The local ethics board approved the protocol. All patient-related data were anonymized after open questions had been resolved in responders who provided their contact information.
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Informed consent was assumed if patients sent in their questionnaire. The local data protection commissioner approved the protocol.
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Wolfgang Höhne and Martin Zeitz are deceased; the manuscript is dedicated to them.
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Kredel, L.I., Schneidereit, O., Hoffmann, J.C. et al. Guideline recommendations for treatment of patients with inflammatory bowel diseases are not implemented in clinical practice—results of a non-representative survey. Int J Colorectal Dis 34, 431–440 (2019). https://doi.org/10.1007/s00384-018-3215-3
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DOI: https://doi.org/10.1007/s00384-018-3215-3