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International Journal of Colorectal Disease

, Volume 34, Issue 7, pp 1233–1240 | Cite as

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

  • Jan C. PreißEmail author
  • Oliver Schneidereit
  • Britta Siegmund
  • Jörg C. Hoffmann
Original Article
  • 76 Downloads

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.

Keywords

Inflammatory bowel diseases Guideline implementation Controlled trial Quality improvement 

Notes

Acknowledgments

We gratefully acknowledge the support of three German statutory sickness funds, the AOK Nordost (Katrin Peise), TK (Christine Vietor), and the AOK Rheinland/Hamburg (Markus Feger), as well as Annegret Schönberg for secretarial assistance and Mary Louise Grossman for English language support. This manuscript is dedicated to the memory of Wolfgang Höhne (1953–2012) and Martin Zeitz (1950–2013).

Funding agency

This study was funded by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung), through the Kompetenznetz Entzündliche Darmerkrankungen (grant number 01 GI 0486).

Compliance with ethical standards

Conflict of interest

J.C.P. served as a consultant for MSD, Pfizer, Takeda, and Biogen and received lecture fees from Vifor, Falk, Janssen, Abbvie, Pfizer, Vifor, MSD, and Takeda. B.S. received a research grant from Pfizer, served as consultant for Falk, Janssen, MSD, Abbvie, Celgene, Lilly, Takeda, Pfizer, and Hospira and received lecture fees from Abbvie, Celgene, Falk, Ferring, Janssen, MSD, Merck, and Takeda; all funds were transferred to the Charité - Universitätsmedizin Berlin, Germany. J.C.H. served as consultant for Amgen, Astra, Falk, Hexal, Janssen, Pfizer, Steigerwald, and Takeda, and received lecture fees from Falk, Janssen, MSD, Pfizer, and Takeda.

Ethical approval

All procedures performed in this study were in accordance with ethical standards of the institutional research committee (approval number EA4/092/09) and with the 1964 Helsinki declaration and its later amendments. All patient-related data were anonymized after open questions had been resolved in responders who provided contact information. The local data protection commissioner approved the study protocol.

Informed consent

Informed consent was assumed if patients sent in their questionnaire.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Medizinische Klinik m. S. Gastroenterologie, Infektiologie und RheumatologieCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  2. 2.Klinik für Innere Medizin—Gastroenterologie, Diabetologie und HepatologieVivantes Klinikum NeuköllnBerlinGermany
  3. 3.Klinik für AnästhesieSegeberger KlinikenBad SegebergGermany
  4. 4.Medizinische Klinik ISt. MarienkrankenhausLudwigshafenGermany

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