Access to Care // Publications
Bernstein MT, Walker JR, Chhibba T, Ivekovic M, Singh H, Targownik LE, Bernstein CN. Health care services in IBD: Factors associated with service utilization and preferences for service options for routine and urgent care. Inflammatory Bowel Diseases 2017; 23(9): 1461-1469.
We aimed to explore factors associated with health service utilization and preference for services, including alternatives to attending the emergency department when experiencing mild to moderate or severe symptoms. A total of 1143 persons (46% response rate) aged 18 to 65 years in the University of Manitoba IBD Research Registry participated in the survey. Although 61% had a gastroenterologist, when experiencing active symptoms, only 29% felt they could call their gastroenterologist for an urgent appointment, and 42% could call their gastroenterologist for telephone advice. 9% of the respondents visited the Emergency Department in the previous year. If having severe symptoms, 48% said that they would attend the Emergency Department. Visits to the Emergency Department were related to higher bowel symptom severity and high health anxiety. When experiencing severe symptoms, women, persons with Crohn's disease (versus persons with ulcerative colitis) and those with high health anxiety, indicated that they would be more likely to use the Emergency Department. Considering services which could be available in the future respondents indicated that if acutely symptomatic they would be very likely or likely to use the following services: phone contact with IBD nurse (77%), phone contact with a gastroenterologist (75%), and going to a walk-in gastroenterology clinic (71%). We concluded that persons with IBD are receptive to options other than the Emergency Department when experiencing IBD symptoms; however, attending the Emergency Department remains a prominent choice. Improved access to specialized care may improve timeliness of care and reduce Emergency Department attendance. Future research should include the impact of health anxiety on health care utilization.
Schoenfeld R, Nguyen G, Bernstein CN. Integrated Care Models:Optimizing Adult Ambulatory Care in Inflammatory Bowel Disease. Journal of Canadian Association of Gastroenterology 2018; in press.
The purpose of this article was to review the literature on outpatient care models used to treat adults with IBD, and to gain insight on how to improve quality of care and reduce costs. A comprehensive review of recent literature on PubMed, Scopus, and Google Scholar databases about care models used to treat IBD was performed. Studies showed that an integrated care model decreases hospital admissions, IBD-related surgeries, and comorbidities of IBD, ultimately decreasing direct and indirect costs of IBD compared to a more traditional patient-physician model. A gastroenterologist-led multidisciplinary team, involving comprehensive care by IBD nurses, a surgeon, psychologist, dietician, pharmacist, and other members as needed is recommended. We concluded that a holistic approach to IBD care delivered by a multidisciplinary team, with structured monitoring, active follow-up, patient education, and prompt access to care improves outcomes for IBD patients. More research is needed on the cost-effectiveness of integrated care models to demonstrate long-term value and secure funding for implementation.
Bernstein CN, Nugent Z, Targownik LE, Singh H, Snider C, Witt J. The cost of use of the Emergency Department by persons with inflammatory bowel disease living in a Canadian health region: A retrospective population based study. Journal of the Canadian Association of Gastroenterology 2019; in press.
We aimed to determine the costs of Emergency Department attendance by persons with inflammatory bowel disease not admitted to hospital from the Emergency Department. This was a population-based administrative database study linking the University of Manitoba IBD Epidemiology Database with the Winnipeg Regional Health Authority (WRHA) Emergency Department Information Service database. We identified persons with IBD who presented to the Emergency Department and were not admitted between January 1, 2009 and March 31, 2012. We then applied costs in Canadian dollars for these visits including an average ED visit cost plus 26% for overhead (total=$508), an average estimated cost of laboratory investigations ($50), and costs for each of radiographic imaging, lower endoscopy, and consultation with an internist/gastroenterologist or a surgeon. We tallied the costs of each unique Emergency Department presentation. We determined average costs for visits associated with specific consultations or investigations.1682 persons with IBD (4853 individual visits) attended the Emergency Department and did not get hospitalized. The average cost per Emergency Department visit by a person with IBD who did not get hospitalized was $650. This resulted in a total expenditure of $3,152,227on these persons for their Emergency Department attendance or $969,916 per year. The visits with the highest mean costs were those associated with an abdominal CT scan ($979), those associated with surgical consultation ($1019) and those associated with an internist/gastroenterologist consultation ($942). Better strategies for management of acute issues for persons with IBD that can reduce the use of an Emergency Department are needed and can be considerably cost saving.