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      The opinion of patients with inflammatory bowel disease on healthcare received Translated title: Opinión de los pacientes con enfermedad inflamatoria intestinal sobre la atención sanitaria recibida

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          Abstract

          Backgrounds and aim: an item to consider in analyzing a healthcare model for a population group suffering from chronic disease is necessary health-care resources, their use, and their rating by endusers. Regarding inflammatory bowel disease (IBD), healthcare resources used by patients are numerous and varied, and yet they have been never assessed. Design: an anonymous self-rated questionnaire has been developed with 24 basic questions on overall disease, who is monitoring the patient, how are visits scheduled, need for urgent care, patient view on how control may be improved, etc. This questionnaire was sent to 393 patients who were asked to fill it out and then return it by mail. Results: two hundred and thirty-seven patients returned a filled-out questionnaire. Most patients were followed up in a hospital, and only 8.8% were being monitored by a general practitioner or area specialist. Ninety-two percent of patients reported visits were routinely scheduled irrespective of clinical status, and 79.6% of patients reported having occasionally presented to an emergency department, because of not knowing what to do or due to having no other resources available in 25.2% of times. This entails that 38% of visits to an emergency unit may be prevented with a better understanding of disease or by means of a phone call. Thirty percent of patients reported that current healthcare is inadequate in terms of contents, form, or waiting time. In all, 97.8% of patients feel that information and knowledge on their disease would help in its control, and 69.6% consider that adequate information would allow them to initiate a proper treatment before visiting their doctor. Family care is another poorly lookedafter aspect that 74.6% of subjects believe would be of help in controlling their disease. Conclusions: overall, the opinion of patients with IBD on healthcare received is good; however, a number of deficiencies were detected, as is the case with insufficient information, care of family members, and healthcare resources accessibility/agility.

          Translated abstract

          Fundamento: un elemento a tener en cuenta al analizar un modelo de atención sanitaria dirigido a un grupo de población afecta de una enfermedad crónica es el de los recursos sanitarios necesarios, su utilización y la valoración que tienen los usuarios de ellos. En la enfermedad inflamatoria intestinal (EII) los recursos sanitarios utilizados por los enfermos son numerosos y variados, pero no han sido evaluados. Diseño: se ha realizado una encuesta autorrellenable anónima de 24 preguntas básicas a cerca de datos generales de la enfermedad, quién les controla, cómo se programan las visitas, necesidad de atención urgente, cómo creen que se puede mejorar su control, etc. La encuesta se remitió al domicilio de 393 pacientes para su contestación y se les pidió que la devolvieran por correo. Resultados: doscientos treinta y siete pacientes devolvieron la encuesta cumplimentada. La mayoría de los pacientes eran controlados en un hospital, y sólo el 8,8% lo eran por el médico de cabecera o especialista de zona. El 92% de pacientes refieren que las visitas se programan de forma rutinaria, independientemente del estado clínico. El 79,6% de pacientes refiere haber acudido alguna vez a urgencias, siendo el motivo en el 25,2% de las ocasiones no saber qué hacer o no tener otro recurso disponible. Ello explica que el 38% de visitas al servicio de urgencias se podrían haber evitado con un mejor conocimiento de la enfermedad o una consulta telefónica. El 30% de pacientes refiere que la actual atención sanitaria es inadecuada, ya sea por su contenido, la forma o el tiempo de espera. El 97,8% de pacientes cree que la información y conocimiento de la enfermedad ayudarían a su control, de forma que el 69,6% considera que con la información adecuada podrían iniciar el tratamiento ya antes de la visita médica. Otro aspecto poco atendido, y que el 74,6% de pacientes opina que ayudaría al control de la enfermedad, es la atención a su entorno familiar. Conclusiones: la opinión general de los pacientes con EII sobre la atención sanitaria recibida es, en general buena, sin embargo se detectan carencias como la información insuficiente, el cuidado al entorno familiar y la accesibilidad-agilidad de los recursos sanitarios.

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          Most cited references31

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          Guided self-management and patient-directed follow-up of ulcerative colitis: a randomised trial.

          Ulcerative colitis is managed mainly in secondary care by regular outpatient reviews done by specialist clinicians. Alternatives would be to discharge patients to primary care or to provide open-access clinics, but neither of these options reduce patients' dependency on doctors or allow patients' involvement in disease management. We did a randomised controlled trial to assess an alternative to traditional outpatient care. We randomly assigned 203 patients with ulcerative colitis who were undergoing hospital follow-up to receive patient-centred self-management training and follow-up on request (intervention group), or normal treatment and follow-up (control group). The main outcome was the interval between relapse and treatment, and secondary outcomes were rates of primary and secondary care consultation, quality of life, and acceptability to patients. Analysis was by intention to treat. Intervention patients had relapses treated within a mean of 14.8 h (SD 19.1) compared with 49.6 h (65.1) in controls (difference 34.8 h [95% CI 16.4-60.2]). Furthermore, intervention patients compared with controls made significantly fewer visits to hospital (0.9 vs 2.9 per patient per year, difference 2.0 [1.6-2.7]) and to the primary-care physician (0.3 vs 0.9 per patient per year, difference 0.6 [0.2-1.1], p<0.006). Only two patients in the intervention group preferred traditional management. Health-related quality-of-life scores were unchanged in both groups. Self-management of ulcerative colitis accelerates treatment provision and reduces doctor visits, and does not increase morbidity. This approach could be used in long-term management of many other chronic diseases to improve health-service provision and use, and to reduce costs.
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            Factors affecting health related quality of life of patients with inflammatory bowel disease.

            Using a disease specific instrument to measure the health related quality of life (HRQOL) of patients with inflammatory bowel disease (IBD), it has been shown that their perceived HRQOL worsens during active disease. The precise factors involved in HRQOL changes reported by these patients are largely unknown. Our aim was to elucidate which socio-demographic and health status variables are related with HRQOL in IBD patients. To this end, 354 patients with IBD were interviewed. To quantify the impairment in the HRQOL, the 36-item version of the inflammatory bowel disease questionnaire (IBDQ) was administered to all patients. To explore the relation of each individual variable on the HRQOL an univariate analysis by using the Spearman correlation, the Mann-Whitney or the Kruskal-Wallis test was performed when necessary. Factors significant at the univariate analysis were assessed using multiple linear regression modeling with global IBDQ score as the dependent factor. Disease type did not predict IBDQ score in the univariate nor in the multivariate analysis. Consequently, statistical analysis was performed in the global group of 354 patients independently of the type of disease. Lower recurrence/year index, longer disease duration, higher level of education, symptom activity, male gender and non-necessity of hospitalization all predict a better HRQOL (p < 0.05). Factors which remained significant (p < 0.05) in the multiple regression modeling were gender, need of hospitalization, symptomatic activity, recurrence/year index and education level. Symptomatic activity and socio-demographic variables such as gender and education are the most important factors involved in the impairment of HRQOL in patients with IBD.
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              Annual cost of care for Crohn's disease: a payor perspective.

              The aim of this study was to estimate the annual cost of care of patients with Crohn's disease according to treatment setting. Using a 1994 integrated claims database, patients with a Crohn's-related medical claim (ICD-9 code 555) from 10/01/94 to 09/30/95 were included in this analysis. These patients were stratified into three mutually exclusive disease severity groups: group 1, required hospitalization for Crohn's; group 2, required chronic glucocorticoid or immunosuppressive drug therapy for >6 months; group 3, all remaining patients. Direct charges (based on reimbursement) and utilization of resources were reported for each group. Six-hundred-seven patients were analyzed: 117(19%) in group 1, 31(5%) in group 2, and 459(76%) in group 3. Average age of all patients was 48 years and 43% of these patients were men. Average annual charges for all patients totaled $12,417. Group I patients experienced the highest mean charges ($37,135), whereas patients in groups 2 and 3 incurred $10,033 and $6,277. Approximately 25% of patients accounted for 80% of the total charges. Crohn's disease is associated with high cost. Although a minority of Crohn's patients required hospitalization, they tended to have higher utilization and were responsible for a majority of total expenditures. New therapies have the potential to reduce overall cost of care, if they prevent Crohn's-related hospitalizations.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                diges
                Revista Española de Enfermedades Digestivas
                Rev. esp. enferm. dig.
                Sociedad Española de Patología Digestiva (Madrid, Madrid, Spain )
                1130-0108
                March 2004
                : 96
                : 3
                : 174-184
                Affiliations
                [01] Barcelona orgnameHospital Universitari Vall d' Hebron orgdiv1Unitat d'Atenció Crohn-Colitis (UACC) orgdiv2Service of Digestive Diseases Spain
                Article
                S1130-01082004000300003
                10.4321/s1130-01082004000300003
                12877c07-735d-458e-b261-80ddee9d0ff8

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 18 September 2003
                : 07 October 2003
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 11
                Product

                SciELO Spain


                Enfermedad de Crohn,Health care,Inflammatory bowel disease,Crohn's disease,Atención sanitaria,Recursos sanitarios,Enfermedad inflamatoria intestinal,Colitis ulcerosa,Information resources,Ulcerative colitis

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