State of IBD care examined

In recent years, significant improvements have been achieved in the delivery of services for patients with inflammatory bowel disease (IBD) and new standards have been established with the aim of improving the quality of care. However, unacceptable gaps in service provision must be addressed, according to the British Society of Gastroenterology (BSG). There is a need to improve the management of the disease – through a more integrated approach across primary and secondary care – to prevent the need for radical surgery, and service provision continues to be “variable”. Inflammatory bowel disease (IBD) affects around 1 in 250 people in the UK. The two main types of IBD are Ulcerative Colitis (UC) and Crohn’s disease (CD) – different disorders, but with a considerable overlap in terms of disability and health service care. Both UC and CD commonly present in adolescence or early adulthood and cause chronic diarrhoea and abdominal pain. At least 80% of people with CD and 25% with UC require surgery at some time, usually excision of intestine or colon and sometimes with stoma formation. There are about 30,000 admissions to hospital per year with exacerbations of IBD and these are associated with some mortality and considerable morbidity. Many deaths occur around the time of surgery (www.rcplondon.ac.uk).

Measuring progress

 The first national IBD audit, which took place in 2006, showed the quality of service provision for patients with this condition varied across the UK. There was a low number of specialist gastroenterologists assigned to wards, relatively few specialist IBD nurses, a high number of beds per toilet, poor dietetic services, infrequent stool sampling and inadequate use of heparin. A second audit has now been undertaken to establish whether improvements have been made, since these initial findings, and the results were recently presented by Dr Ian Arnott, UK IBD audit clinical lead, at the British Society of Gastroenterology’s conference held in Glasgow. The audit was a collaborative partnership between gastroenterology physicians (the British Society of Gastroenterology), colorectal surgeons (the Association of Coloproctology of Great Britain and Ireland), patients (the National Association for Colitis and Crohn’s Disease) and the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit. The work was led by a multidisciplinary Steering Group that included IBD clinical nurse specialists, dietitians, pharmacists and NHS commissioners, as well as representatives from the partnership organisations, and was funded by a grant from the Health Foundation. Some 209 sites submitted data on over 6,000 patients for this latest study, resulting in an 87% participation rate by hospitals – a significant improvement on the previous audit. The report showed that activity and mortality have not significantly changed since 2006 – the median number of admissions is 50 for UC and 60 for CD, while inpatient mortality is 1.5% and 1.1% respectively. Dr Arnott pointed out that there have been improvements in a number of areas of care for patients with IBD since 2006. Progress has been achieved in terms of the increased provision of dedicated gastroenterology wards, the number of IBD clinical nurse specialists and the time that they dedicate to IBD care.