Are Primary Care Providers Uncomfortable Providing Routine Preventive Care for Inflammatory Bowel Disease Patients?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Background and Aims
Those with chronic diseases, including inflammatory bowel disease (IBD), often do not receive preventive care at the same rate as the general population. Attitudes of primary care providers could be key factors in the receipt of preventive care.
We surveyed attendees of a family medicine review course. The survey contained nine demographic items, four items to assess exposure to and comfort level with IBD, and six clinical vignettes.
Of surveys, 36% (61/169) were returned. The large majority were males practicing outpatient family medicine. Mean age was 51 years, and 48% reported a mostly rural practice. Of subjects, 10% reported either having IBD themselves or having a close associate or relative with IBD. Only 37% of subjects felt comfortable providing primary care across a range of illness severity. Forty-six percent reported moderate or high exposure to IBD. For the case vignettes, the overall highest rate of endorsement of the active role was 84% for a case related to stage I hypertension, while the lowest rate was 30% for an item relating to vaccination for immunosuppressed persons. We assessed the following predictors of comfort level and active role responses and found no significant associations: age, gender, years of medical practice, and close contact with IBD.
Our study suggests that family medicine practitioners often do not feel comfortable providing care to IBD patients. Lack of familiarity with IBD medications may be a key factor.
- Kremers, HM, Bidaut-Russell, M, Scott, CG (2003) Preventive medical services among patients with rheumatoid arthritis. J Rheumatol 30: pp. 1940-1947
- Redelmeir, DA, Tan, SH, Booth, GL (1998) The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med 338: pp. 1516-1520 CrossRef
- Kiefe, CI, Funkhouser, E, Fouad, MN (1998) Chronic disease as a barrier to breast and cervical cancer screening. J Gen Intern Med 338: pp. 357-365 CrossRef
- Beckman, TJ, Cuddihy, RM, Scheitel, SM (2001) Screening mammogram utilization in women with diabetes. Diabetes Care 24: pp. 2049-2053 CrossRef
- Winkelmayer, WC, Owen, W, Glynn, RJ (2002) Preventive health care measures before, after start of renal replacement therapy. J Gen Intern Med 17: pp. 588-595 CrossRef
- Lipscombe, LL, Hux, JE, Booth, GL (2005) Reduced screening mammography among women with diabetes. Arch Intern Med 165: pp. 2090-2095 CrossRef
- Selby, L, Kane, S, Wilson, J (2008) Receipt of preventive health services by ibd patients is significantly lower than by primary care patients. Inflamm Bowel Dis 14: pp. 253-258 CrossRef
- Melmed, GY, Ippoliti, AF, Papadakis, KA (2006) Patients with inflammatory bowel disease are at risk for vaccine-preventable illnesses. Am J Gastroenterol 101: pp. 1834-1840 CrossRef
- Bodenheimer, T (2006) Primary care—will it survive. NJEM 355: pp. 861-864 CrossRef
- Yarnall, SH, Pollack, KI, Ostbyte, T (2003) Primary care: is there enough time for prevention?. Am J Public Health 93: pp. 635-641 CrossRef
- The Guide to Clinical Preventive Services 2006: Recommendations of the US Preventive Services Task Force. AHRQ Publication Number 06–0588.
- Advisory Committee on Immunization Practices. http://www.cdc.gov/vaccines/recs/acip/. Accessed 2/10/2007.
- Jess, T, Loftus, EV, Harmsen, WS (2006) Survival and cause specific mortality in patients with inflammatory bowel disease: a long term outcome study in Olmstead County, Minnesota, 1940–2004. Gut 55: pp. 1248-1254 CrossRef
- Farrokhyar, F, Swarbrick, ET, Grace, RH (2001) Low mortality in ulcerative Colitis and Crohn’s disease in three regional centers in England. Am J Gastroenterol 96: pp. 501-507 CrossRef
- Card, T, Hubbard, R, Logan, RFA (2003) Mortality in inflammatory bowel disease: a population-based Cohort study. Gastroenterology 125: pp. 1583-1590 CrossRef
- Rosenthal, MB, Landon, BE, Normand, S-LT (2006) Pay for performance in commercial HMOS. N Engl J Med 335: pp. 1895-1902 CrossRef
- Petersen, LA, LeChauncy, DW, Urech, T (2006) Does pay-for-performance improve the quality of health care?. Ann Intern Med 145: pp. 265-272
- Hillman, AL, Ripley, K, Goldfarb, N (1998) Physician financial incentives and feedback: failure to increase cancer screening in medicaid managed care. Am J Public Health 88: pp. 1699-1701 CrossRef
- Roski, J, Jeddeloh, R, An, L (2003) The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation guidelines. Prev Med 36: pp. 291-299 CrossRef
- Kouides, RW, Bennett, NM, Lewis, B (1998) Performance-based physician reimbursement and influenza immunization rates in the elderly. The primary-care physicians of Monroe County. Am J Prev Med 14: pp. 89-95 CrossRef
- Rosenthal, MB, Frank, RG, Li, Z (2005) Early experience with pay-for performance: from concept to practice. JAMA 294: pp. 1788-1793 CrossRef
- Fryer, GE, Consoli, R, Miyoshi, TJ (2004) Specialist physicians providing primary care services in Colorado. J Am Board Fam Pract 17: pp. 81-90 CrossRef
- Lloyd, J. Doctor shortage looms as primary care loses its pull. http://www.usatoday.com/news/health/2009-08-17-doctor-gp-shortage_N.htm. Accessed 10/28/09.
- The Robert Graham Center Update: A Primary Care Perspective on Health Care Workforce and Expenditures. http://www.graham-center.org/online/etc./medialib/graham/documents/publications/presentations/2009/rgcps-slides-pdf.Par.0001.File.tmp/rgc-slides-3-09.pdf. Accessed 10/28/09.
- US Census Bureau Fact Finder. http://factfinder.census.gov/home/saff/main.html?_lang=en. Accessed 3/15/10.
- Census 2000 Urban and Rural Classification. http://www.census.gov/geo/www/ua/ua_2k.html. Accessed 3/15/10.
- Are Primary Care Providers Uncomfortable Providing Routine Preventive Care for Inflammatory Bowel Disease Patients?
Digestive Diseases and Sciences
Volume 56, Issue 3 , pp 819-824
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Inflammatory bowel disease
- Primary care
- Preventive care
- Chronic disease
- Industry Sectors
- Author Affiliations
- 1. Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, MN 649, Lexington, KY, 40536, USA
- 2. Department of Internal Medicine, Division of General Internal Medicine, University of Kentucky Medical Center, K509 Kentucky Clinic, Lexington, KY, 40536-0284, USA
- 3. Department of Behavioral Science, University of Kentucky, 123 College of Medicine Office Building, Lexington, KY, 40536-0086, USA