Disparity in clinical care for patients with inflammatory bowel disease between specialists and non-specialists

Tomoko Hirakawa, Jun Kato, Sakuma Takahashi, Hideyuki Suzuki, Mitsuhiro Akita, Izumi Inoue, Hisanobu Deguchi, Sakiko Hiraoka, Hiroyuki Okada, Kazuhide Yamamoto

Department of Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.

DOI: 10.4236/ojgas.2013.31010                

Abstract

Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long-term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera-peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.

Keywords

Inflammatory Bowel Disease; Clinical Care; Specialist

Conflicts of Interest

The authors declare no conflicts of interest.

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