Top

International Journal of Colorectal Disease

Published in:

01-07-2019 | Ulcerative Colitis | Original Article

Improving treatment of patients with inflammatory bowel diseases: a controlled trial of a multifaceted intervention in two German cities

Authors: Jan C. Preiß, Oliver Schneidereit, Britta Siegmund, Jörg C. Hoffmann

Published in: International Journal of Colorectal Disease | Issue 7/2019

Abstract

Purpose

Many recommendations from clinical practice guidelines are not implemented. We aimed to develop and evaluate a multifaceted strategy for the implementation of guidelines for Crohn’s disease (CD) and ulcerative colitis (UC).

Methods

In the intervention region (Berlin, Germany), a continuing medical education course was held, brief guidelines for practice were distributed to all family physicians and gastroenterologists, and patient guidelines were distributed to all surveyed patients. Educational outreach visits with local opinion leaders were also conducted. No specific interventions were performed in the control region (Hamburg, Germany). Prior to the intervention and 1 year later, 1900 members of three statutory sickness funds were asked about their treatment according to guidelines with (1) long-term aminosalicylates and (2) immunosuppressants, (3) whether they took long-term glucocorticoids for maintenance of remission, (4) if they smoked, in CD patients, and (5) about the surveillance colonoscopies, in UC patients.

Results

Response rate after implementation was 20.1%. Responders differed between intervention and control region by age and by distribution between patients with UC or CD. After 1 year, more patients were treated according to clinical practice guidelines in the control region than in the intervention region. More patients in the intervention region took immunosuppressants after 1 year, and fewer had a surveillance colonoscopy. However, no before–after comparison was statistically significant.

Conclusions

This implementation strategy of UC and CD guidelines did not result in a statistically significant effect. Future implementation of guidelines for inflammatory bowel disease might need thorough evaluation of barriers and the support of theory-based concepts.

Available only for authorised users

Colombel J-F, Narula N, Peyrin-Biroulet L (2017) Management strategies to improve outcomes of patients with inflammatory bowel diseases. Gastroenterology 152:351–361.e5. https://doi.org/10.1053/j.gastro.2016.09.046 CrossRefPubMed

Grimshaw JM, Shirran L, Thomas R et al (2001) Changing provider behavior: an overview of systematic reviews of interventions. Med Care 39:II2–I45CrossRefPubMed

Chauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta A, Zarychanksi R (2017) Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews. Implement Sci IS 12:3. https://doi.org/10.1186/s13012-016-0538-8 CrossRefPubMed

Berry SK, Siegel CA, Melmed GY (2017) Quality improvement initiatives in inflammatory bowel disease. Curr Gastroenterol Rep 19:41. https://doi.org/10.1007/s11894-017-0581-x CrossRefPubMed

Kredel LI, Schneidereit O, Hoffmann JC, Siegmund B, Preiß JC (2018) Guideline recommendations for treatment of patients with inflammatory bowel diseases are not implemented in clinical practice—results of a non-representative survey. Int J Color Dis 34:431–440. https://doi.org/10.1007/s00384-018-3215-3 CrossRef

Reynolds C, Esrailian E, Hommes D (2018) Quality improvement in gastroenterology: a systematic review of practical interventions for clinicians. Dig Dis Sci 63:2507–2518. https://doi.org/10.1007/s10620-018-5198-x CrossRefPubMed

Walsh AJ, Weltman M, Burger D, Vivekanandarajah S, Connor S, Howlett M, Radford-Smith G, Selby W, Veillard AS, Grimm MC, Travis SPL, Lawrance IC (2013) Implementing guidelines on the prevention of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 7:e449–e456. https://doi.org/10.1016/j.crohns.2013.02.019 CrossRefPubMed

Greene L, Sapir T, Moreo K, Carter JD, Patel B, Higgins PDR (2015) Impact of quality improvement educational interventions on documented adherence to quality measures for adults with Crohn’s disease. Inflamm Bowel Dis 21:2165–2171. https://doi.org/10.1097/MIB.0000000000000462 CrossRefPubMed

Greene L, Moreo K (2015) Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with national quality strategy priorities. BMJ Qual Improv Rep 4. https://doi.org/10.1136/bmjquality.u208829.w3554

10.

Sapir T, Moreo K, Carter JD, Greene L, Patel B, Higgins PDR (2016) Continuing medical education improves gastroenterologists’ compliance with inflammatory bowel disease quality measures. Dig Dis Sci 61:1862–1869. https://doi.org/10.1007/s10620-016-4061-1 CrossRefPubMed

11.

Christensen KR, Steenholdt C, Buhl SS, Ainsworth MA, Thomsen OØ, Brynskov J (2015) Systematic information to health-care professionals about vaccination guidelines improves adherence in patients with inflammatory bowel disease in anti-TNFα therapy. Am J Gastroenterol 110:1526–1532. https://doi.org/10.1038/ajg.2015.162 CrossRefPubMed

12.

Bokemeyer B (2003) Kosten der allgemeinmedizinischen Versorgung von Patienten mit chronisch-entzündlichen Darmerkrankungen. Z Gastroenterol 41:963–964. https://doi.org/10.1055/s-2003-41830 CrossRefPubMed

13.

Amelung V, Wolf S, Hildebrandt H (2012) Integrated care in Germany—a stony but necessary road! Int J Integr Care 12. https://doi.org/10.5334/ijic.853

14.

Busse R, Blümel M, Knieps F, Bärnighausen T (2017) Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. Lancet 390:882–897. https://doi.org/10.1016/S0140-6736(17)31280-1 CrossRefPubMed

15.

Stange EF, Schreiber S, Fölsch UR, von Herbay A, Schölmerich J, Hoffmann J, Zeitz M, Fleig WE, Buhr HJ, Kroesen AJ, Moser G, Matthes H, Adler G, Reinshagen M, Stein J (2003) Diagnostik und Therapie des M. Crohn—Ergebnisse einer evidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft für Verdauungs-und Stoffwechselkrankheiten. Z Gastroenterol 41:19–20. https://doi.org/10.1055/s-2003-36661

16.

Hoffmann JC, Zeitz M, Bischoff SC, Brambs HJ, Bruch HP, Buhr HJ, Dignaß A, Fischer I, Fleig W, Fölsch UR, Herrlinger K, Höhne W, Jantschek G, Kaltz B, Keller KM, Knebel U, Kroesen AJ, Kruis W, Matthes H, Moser G, Mundt S, Pox C, Reinshagen M, Reißmann A, Riemann J, Rogler G, Schmiegel W, Schölmerich J, Schreiber S, Schwandner O, Selbmann HK, Stange EF, Utzig M, Wittekind C (2004) Diagnostik und Therapie der Colitis Ulcerosa: Ergebnisse einer evidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen zusammen mit dem Kompetenznetz chronisch entzündliche Darmerkrankungen. Z Gastroenterol 42:979–983. https://doi.org/10.1055/s-2004-813510 CrossRefPubMed

17.

Hiss RG, Macdonald R, David WR (1978) Identification of physician educational influentials (EI’s) in small community hospitals. Annu Conf Res Med Educ 17:283–288

18.

Münch C, Gottschall M, Hübsch G, Köberlein-Neu J, Schübel J, Bergmann A, Voigt K (2016) Quality of documented diagnosis in primary care—an analysis using the example of thyroid disorders. Z Für Evidenz Fortbild Qual Im Gesundheitswesen 115:56–62. https://doi.org/10.1016/j.zefq.2016.03.016 CrossRef

19.

Erler A, Beyer M, Muth C, Gerlach FM, Brennecke R (2009) Garbage in—garbage out? Validität von Abrechnungsdiagnosen in hausärztlichen Praxen. Gesundheitswesen 71:823–831. https://doi.org/10.1055/s-0029-1214399 CrossRef

20.

O’Brien MA, Rogers S, Jamtvedt G et al (2007) Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev:CD000409. https://doi.org/10.1002/14651858.CD000409.pub2

21.

Forsetlund L, Bjørndal A, Rashidian A et al (2009) Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev:CD003030. https://doi.org/10.1002/14651858.CD003030.pub2

22.

Flodgren G, Parmelli E, Doumit G, Gattellari M, O'Brien MA, Grimshaw J, Eccles MP, Cochrane Effective Practice and Organisation of Care Group (2011) Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000125.pub4

23.

Flodgren G, Hall AM, Goulding L, Eccles MP, Grimshaw JM, Leng GC, Shepperd S, Cochrane Effective Practice and Organisation of Care Group (2016) Tools developed and disseminated by guideline producers to promote the uptake of their guidelines. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010669.pub2

24.

Fønhus MS, Dalsbø TK, Johansen M, Fretheim A, Skirbekk H, Flottorp SA, Cochrane Effective Practice and Organisation of Care Group (2018) Patient-mediated interventions to improve professional practice. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012472.pub2

25.

Melmed GY, Siegel CA, Spiegel BM, Allen JI, Cima R, Colombel JF, Dassopoulos T, Denson LA, Dudley-Brown S, Garb A, Hanauer SB, Kappelman MD, Lewis JD, Lynch I, Moynihan A, Rubin DT, Sartor RB, Schwartz RM, Wolf DC, Ullman TA (2013) Quality indicators for inflammatory bowel disease: development of process and outcome measures. Inflamm Bowel Dis 19:662–668. https://doi.org/10.1097/mib.0b013e31828278a2 CrossRefPubMed

26.

ICHOM | inflammatory bowel disease standard set | measuring outcomes. In: ICHOM—Int. Consort Health Outcomes Meas https://www.ichom.org/medical-conditions/inflammatory-bowel-disease/. Accessed 2 Dec 2018

27.

Fischer F, Lange K, Klose K, Greiner W, Kraemer A (2016) Barriers and strategies in guideline implementation—a scoping review. Healthcare 4. https://doi.org/10.3390/healthcare4030036

28.

Johnson MJ, May CR (2015) Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open 5:e008592. https://doi.org/10.1136/bmjopen-2015-008592 CrossRefPubMedPubMedCentral

Title: Improving treatment of patients with inflammatory bowel diseases: a controlled trial of a multifaceted intervention in two German cities
Authors: Jan C. Preiß
Oliver Schneidereit
Britta Siegmund
Jörg C. Hoffmann
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Keywords: Ulcerative Colitis
Crohn's Disease
Chronic Inflammatory Bowel Disease
Glucocorticoid
Published in: International Journal of Colorectal Disease / Issue 7/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03317-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Improving treatment of patients with inflammatory bowel diseases: a controlled trial of a multifaceted intervention in two German cities

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2019

Management of cecal diverticulitis diagnosed by computed tomography scan

The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections

Randomized controlled trial to evaluate laparoscopic versus open surgery in transverse and descending colon cancer patients

Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery—a national population-based cohort study

Omental flaps in patients undergoing abdominoperineal resection for rectal cancer

Postoperative functional outcomes and complications of partially intraanal canal anastomosis in stapled ileal pouch anal anastomosis for ulcerative colitis