|
 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.
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.
[to top of second column] |
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: http://bit.ly/2rodxH9 Inflammatory Bowel Diseases, online
May 16, 2017
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
