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https://hdl.handle.net/2440/71259
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Type: | Journal article |
Title: | An integrated model of care for inflammatory bowel disease sufferers in Australia: Development and the effects of its implementation |
Author: | Mikocka-Walus, A. Turnbull, D. Holtmann, G. Andrews, J. |
Citation: | Inflammatory Bowel Diseases, 2012; 18(8):1573-1581 |
Publisher: | John Wiley & Sons, Inc |
Issue Date: | 2012 |
ISSN: | 1536-4844 1536-4844 |
Statement of Responsibility: | Antonina A. Mikocka-Walus, Deborah Turnbull, Gerald Holtmann and Jane M. Andrews |
Abstract: | BACKGROUND: Psychological comorbidities are associated with poor outcome and increased healthcare utilization in patients with inflammatory bowel disease (IBD). However, a model of care addressing the biopsychosocial dimension of disease is not routinely applied in IBD. This review describes the development of such a model and the effects of its implementation in a hospital-based cohort of patients with IBD. METHODS: Three different approaches were used: 1) collecting baseline epidemiological data on mental health comorbidities; 2) raising awareness of and targeting mental health problems; 3) examining the effects of the model implementation. RESULTS: High rates of anxiety and depressive symptoms (36% and 13%, respectively) that are maintained over time were identified in IBD patients presenting at a metropolitan teaching hospital. Patients with documented psychological comorbidities were more likely to be hospitalized than those without (odds ratio [OR] = 4.13, 95% confidence interval [CI]: 1.25, 13.61). Improvements in disease activity, anxiety, depression, quality of life, and coping have been noted when cognitive-behavioral therapy (CBT) was provided to patients. A drop in the use of opiates (P = 0.037) and hospitalization rates (from 48% to 30%) in IBD patients has been noted as a result of introduction of the changed model of care. In addition, the mean total cost of inpatient care was lower for IBD patients than controls (US$12,857.48 [US$15,236.79] vs. US$ 30,467.78 [US$ 53,760.20], P = 0.005). CONCLUSION: Our data to date suggest that an integrated model of care for patients with IBD may yield superior long-term outcomes in terms of medication use and hospitalization rates and reduce healthcare costs. |
Keywords: | Integrated model of care biopsychosocial psycho-gastroenterology inflammatory bowel disease mental health health systems |
Rights: | Copyright © 2011 Crohn's & Colitis Foundation of America, Inc. |
DOI: | 10.1002/ibd.22850 |
Published version: | http://dx.doi.org/10.1002/ibd.22850 |
Appears in Collections: | Aurora harvest Medicine publications |
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