IBD patients living far from specialists may not get needed care

By Shereen Lehman

(Reuters Health) - The further away inflammatory bowel disease (IBD) patients live from specialist doctors, the more likely they are to need IBD-related surgery or drug therapy to manage their disease, a small study suggests.

Because people with Crohn’s disease and ulcerative colitis - collectively known as IBD - require specialized care, having to travel long distances to get it may lead to worse outcomes, the study team writes in the journal Inflammatory Bowel Diseases.
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Advances in drug therapy have increased IBD patients’ treatment options and starting these therapies early may be key to success, the authors write. Previous studies have also found that mortality is much lower in IBD patients who are treated by gastroenterologists who specialize in these diseases, they note.

 “There’s a good amount of literature now that high volume hospitals and specialist experience is important for better IBD outcomes. However, we also recognize that access to such care is not always possible,” senior study author Dr. Ashwin Ananthakrishnan told Reuters Health in an email.

“So we wanted to examine to what extent geographic barriers such as distance may place in influencing IBD outcomes,” said Ananthakrishnan, a gastroenterologist at Massachusetts General Hospital in Boston.

The researchers used zip code and medical information from a registry that includes adult IBD patients who get their care at the hospital to place 2,136 patients into one of four groups based on travel distance from their homes. The average travel distance in each of the groups was 2.5 miles for those who lived closest, 8.8 miles, 22 miles and 50.8 miles for those who lived furthest from the hospital.

Based on treatment records, the study team found that patients who lived the furthest from the hospital had more than double the likelihood of needing surgery compared to those who lived the closest.

“Greater travel distance may affect need for surgery in patients with IBD by impeding early initiation of effective treatment,” the authors write.

The patients who lived the furthest away were also 69 percent more likely than those living closest to the hospital to need immunotherapy drugs and more than twice as likely to need biologic therapies.

“I think it is important for us to understand what it is that may be done differently at high volume centers - perhaps earlier initiation of effective and steroid-sparing therapy, appropriate thresholds for surgery, expert surgeons, etc.,” Ananthakrishnan said.

We need to identify those differences and replicate them in more remote centers since it is not possible for all patients to receive their entire care at high-volume centers, he added.

“From a patient standpoint, it is important for them to be engaged in the management of IBD, understand risk profiles of treatment, importance of effective treatment early, and their likelihood of complications or disease progression,” Ananthakrishnan said.

Patients should also discuss their problems with their gastroenterologist if they are not getting the answers to these questions, he said.

Ananthakrishnan noted that telemedicine would be helpful to answer some of these questions.

“Not all questions can be answered through (telemedicine), and I think care of some patients can be complicated. But for many, it should be ok,” he said.

Among the limitations of the study is that it only involved one location, and it’s possible that patients who lived the furthest away were referred to the hospital because their cases were more severe.

“There is need for further studies to determine how specialized IBD care may be provided in a decentralized way to optimize patient outcomes,” the authors write.

SOURCE: bit.ly/2rodxH9 Inflammatory Bowel Diseases, online May 16, 2017.