Multidisciplinary Care Essential in Optimal IBD Treatment

Multidisciplinary teams with clinical nurses, nurse practitioners, and gastroenterologists closely working together have successfully decreased the rates of hospitalization for inflammatory bowel disease, agreed  Emanuelle Bellaguarda, MD, Emily Block, RN, and Erin Darguzas, APRN, CNP, in the nursing breakout session on December 5 at the Advances in Inflammatory Bowel Disease annual meeting in Orlando, Florida.

Dr Bellaguarda is an assistant professor of medicine and a gastroenterologist specializing in IBD at Northwestern University in Chicago, Illinois. She is the director of the Advanced Inflammatory Bowel Disease Fellowship, and she also leads Northwestern University’s fecal transplant program and immune-mediated colitis toxicity service.

Block is a registered nurse in the IBD department at Northwestern Memorial Hospital in Chicago, Illinois. One of the lead nurses in the IBD specialty, Block has helped spearhead quality improvement projects and assisted in the opening of the IBD infusion center at Northwestern.

Darguzas is a certified nurse practitioner at Northwestern Medicine in Chicago, Illinois. A professional member of American Gastroenterological Association and Crohn’s and Colitis Foundation, Darguzas has been involved in the care of patients with IBD since 2013.

“IBD patients are complex and need a team that they can rely on for continuity of care,” said Dr Bellaguarda during the panel discussion. “New models of care are evolving to a patient-centered system, and this requires high level and quality care involving a multidisciplinary team in which the clinical nurse, nurse practitioner, and gastroenterologist work closely together to provide optimal care.”

Providing the correct and most effective treatment plan for patients with IBD is all-encompassing because the disease itself presents a lot of complexities, they said. For example, 85% of patients report decreased quality of life. Patients with IBD often struggle with anxiety and depression too, and they require more urgent visits, frequent colonoscopies and hospitalizations. Because of their increased chances of relapse, the patients may benefit from close follow up, better education and awareness and medication adjustment.

A “multidisciplinary approach,” the panelists explained, involves collaboration among the clinical nurses, doctors, ostomy nurses, pharmacists, dietitians, advance practice providers and behavioral health team. To highlight the importance of nurses in the treatment of IBD, they cited a 2021 Australian study by Karimi et al, which showed that there were significant reductions in emergency visits related to IBD, hospitalizations, and IBD outpatient visits after setting up twice-weekly IBD nurse consultation to discuss management plans. The IBD nurse also served as the communication point between the patient and general practitioner.

Other research on the quality of IBD care found that patients could avoid at least 30 emergency room visits and 133 outpatient visits over a 12-month period when they worked with a team including an IBD nurse specialist. The nurses provided a focal point for scheduling follow-up, providing disease information and support, guidance in starting new therapies, managing flare-ups, and providing administrative and psychological support.

A health care professional electronic survey of 49 physicians and 88 nurses in Finland found that “the most important IBD nurse contributions listed were patient support and follow up with 79-81% of the respondents vouching for it.” Additionally, clinics with an IBD nurse reported less patient hospitalization (4-9% vs 11-19%, p<0.001), and as well as significant reductions in estimated annual costs.

While the gastroenterologist can manage the complex patient problems in clinic and hospital setting and perform procedures, an IBD nurse coordinator can draw up a comprehensive care plan in alignment with the patient and team care goals, assist in medication refills, provide first patient contact and educate the patient about medication. A nurse practitioner can enable first-line medical assessment, remote monitoring, follow-up after emergency room visits, and inpatient hospitalization to provide flexible care plans according to each patient’s needs.

A recent study found that there will be an estimated shortfall of between 42,600 and 121,300 physicians by 2030, which greatly increases the need for advance practice providers. “There is approximately 1 advance practice provider for every 3 physicians in practice,” Dr Bellaguarda said.

The advance practice providers work side by side with physicians to provide seamless and efficient care to patients with not only IBD but also IBS, GERD, liver disease, and other conditions. They also perform diagnostic procedures, conduct research, and order diagnostic tests, while providing routine health maintenance education and management.

Patients with gastrointestinal issues would benefit greatly from the combined medical specialties and training methodologies of a multidisciplinary team, said Block and Darguzas.

—Priyam Vora

Reference:
Bellaguarda E, Block E and Darguzas E. What is the provider-RN role and how do we work as a team? Presented at: Advances in Inflammatory Bowel Disease Annual Meeting. December 5, 2022. Orlando, Florida.