A survey of GPs treating patients with inflammatory bowel disease (covering patients with ulcerative colitis and Crohn’s disease) found that GPs wanted more information about local services for their patients.
The survey was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out on behalf of the UK IBD Audit Steering Group by the RCP’s Clinical Effectiveness and Evaluation Unit (CEEU). GPs returned 1675 completed questionnaires out of a maximum of 6640 related admissions.
GPs are likely to see only a handful of new patients with IBD each year, compared to many patients with more common conditions, and therefore it is crucial for them to have prompt access to specialist advice.
The survey showed that GPs wanted to ensure their patients with IBD who suffered a relapse of symptoms are seen at the hospital clinic within 7 days of contact; 59% have not been able to access such speedy review.
The survey also showed that encouragingly, the majority of patients with IBD (76%) are under the care of a hospital for the long term follow up of their condition.
The report makes several recommendations aimed at improving education, information and communication about IBD services between GPs and hospital services:
- Secondary care and the Royal College of Nursing Crohn’s and Colitis Specialist Interest Group should promote and raise awareness of the role IBD specialist nurses and the support that they can offer to primary care in making treatment choices and preventing admission to hospital.
- Hospitals should always provide GPs with a copy of a patient’s most up to date care management plan. This plan should clearly indicate named individuals who can be contacted for advice in the event of a relapse, including any details of an IBD nurse specialist where one is in post.
- The Primary Care Society for Gastroenterology could coordinate educational events with primary and secondary care input to promote the latest knowledge in relation to the treatment of IBD.
- The Primary Care Society for Gastroenterology could encourage general practice research into the number of patients who have been diagnosed with IBD but who are not currently being seen either in primary or secondary care.
- An understanding of the colon cancer surveillance requirements should be en educational objective of general practitioners.
Dr Ian Arnott, consultant gastroenterologist, Western General Hospital, Edinburgh & clinical director for the UK IBD Audit, said:
This timely report shows for the first time significant issues in communication between primary and secondary care services for patient with IBD. The report also highlights a number of educational issues surrounding the long term follow up of patient with IBD. This report serves as a basis for commissioners and their secondary care colleagues to work together to establish seamless pathways in the patient journey ensuring the best quality management of IBD patients.
Dr John O’Malley, secretary of the Primary Care Society for Gastroenterology, said:
This audit highlights the need for better working together between primary and secondary care with better recognition and treatment of flare ups in IBD needed on the primary care side and better provision of ‘fast track’ access to hospital care. It also shows that a greater awareness of the potentially valuable role that IBD nurses could play in primary care is needed.
Dr Kevin Stewart, clinical director of the RCP’s Clinical Effectiveness and Evaluation Unit (CEEU), said:
There have been many welcomed improvements in the care of IBD patients but we clearly have to now focus on improving coordination of services between GPs and the hospital. We know that GPs are incredibly busy and individual doctors may not see many IBD patients, so we have to ensure that when patients need specialist care there are easy ways for GPs to access this.
- The inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) are common causes of gastrointestinal morbidity. The total cost of IBD to the NHS has been estimated at £720 million, based on an average cost of £3,000 per patient per year, with up to half of total costs attributed to relapsing patients. Up to 25% of cases will present in childhood years with a marked rise in the incidence of paediatric IBD noted in the UK over the past few decades.