Barriers to Successful Outcomes in Patients with Inflammatory Bowel Diseases

Chapter
First Online:

Abstract

Attaining successful outcomes in inflammatory bowel disease (IBD) can be challenging. The nature of these diseases can result in impaired quality of life and strict adherence to treatment regimens is paramount. Endpoints in IBD treatment are complex; therefore, managing these patients can be difficult at times. Patient-specific obstacles to achieving success include patient education, perception of disease and acceptance of risk, socioeconomic factors, psychiatric disease, and adherence to treatment. Physician dynamics, including providing high-quality care and physician perceptions, also may hinder overall outcomes of patients. This chapter explores elements contributing to poor patient outcomes and aims to provide solutions to overcome these obstacles.

Keywords

Outcome measure Adherence Education Quality of care Inflammatory bowel disease (IBD) 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104:465–83.CrossRefPubMedGoogle Scholar
  2. 2.
    Kornbluth A, Sachar DB. Ulcerative colitis in adults. Am J Gastroenterol. 2010;105:500–23.CrossRefGoogle Scholar
  3. 3.
    Levesque BG, Sandborn WJ, Riel J, Feagan BG, Sands BE, Colombel J. Converging goals of treatment of inflammatory bowel disease from clinical trials and practice. Gastroenterology. 2015;148:37–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Henderson P, van Limbergen JE, Schwarze J, Wilson DC. Function of the intestinal epithelium and its dysregulation in inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:382–95.CrossRefPubMedGoogle Scholar
  5. 5.
    Neurath MF, Travis SP. Mucosal healing in inflammatory bowel diseases: a systematic review. Gut. 2012;61:1619–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Centers for Medicare & Medicaid. Baltimore MD: Centers for Medicare & Medicaid; 2014. PQRS Reporting Measures List 2014; 2014 Jan 23 [cited 2015 Feb 24]. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html.
  7. 7.
    Siegel CA, Allen JI, Melmed GY. Translating improved quality of care into an improved quality of life for patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2013;11:908–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Centers for Medicare & Medicaid. Baltimore MD: Centers for Medicaire & Medicaid; 2014. PQRS Payment Adjustment Information; 2015 Feb 10 [cited 2015 Feb 24]. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Payment-Adjustment-Information.html.
  9. 9.
    Linn AJ, van Dijk L, Smit EG, Jansen J, van Weert JC. May you never forget what is worth remembering: the relation between recall of medical information and medication adherence in patients with inflammatory bowel disease. J Crohns Colitis. 2013;7:543–50.CrossRefGoogle Scholar
  10. 10.
    Siegel CA, Levy LC, Mackenzie TA, Sands BE. Patient perceptions of the risks and benefits of infliximab for the treatment of inflammatory bowel disease. Inflamm Bowel Dis. 2008;14:1–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Bernard A, Langille M, Hughes S, Rose C, Leddin D, Veldhuyzen van Zanten S. A systematic review of patient inflammatory bowel disease information resources on the World Wide Web. Am J Gastroenterol. 2007;102:2070–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Langille M, Bernard A, Rodgers C, Hughes S, Leddin D, van Zanten SV. Systematic review of the quality of patient information on the internet regarding inflammatory bowel disease treatments. Clin Gastroenterol Hepatol. 2012;8:322–8.CrossRefGoogle Scholar
  13. 13.
    van der Marel S, Duijvestein M, Hardwick JC, van den Brink GR, Veenendaal R, Hommes DW, et al. Quality of web-based information on inflammatory bowel diseases. Inflamm Bowel Dis. 2009;15:1891–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Siegel CA. Lost in translation: helping patients understand the risks of inflammatory bowel disease therapy. Inflamm Bowel Dis. 2010;12:2168–72.CrossRefGoogle Scholar
  15. 15.
    Siegel CA. Shared decision making in inflammatory bowel disease: helping patients understand the tradeoffs between treatment options. Gut. 2012;61:456–65.CrossRefGoogle Scholar
  16. 16.
    Baars JE, Markus T, Kuipers EJ, van der Woulde CJ. Patients’ preferences regarding shared decision-making in the treatment of inflammatory bowel disease: results from a patient empowerment study. Digestion. 2010;81:113–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Johnson FR, Hauber AB, Ozdemir S, Siegel CA, Haas S, Sands BE. Are gastroenterologists less tolerant of treatment risks than patients? Benefit-risk preferences in Crohn’s disease management. J Manag Care Pharm. 2010;16:616–28.PubMedGoogle Scholar
  18. 18.
    Colombel J, Sandborn W, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–95.CrossRefPubMedGoogle Scholar
  19. 19.
    Johnson FR, Ozdemir S, Mansfield C, Haas S, Miller DW, Siegel CA, et al. Crohn’s disease patients’ risk-benefit preferences: serious adverse event rate versus treatment efficacy. Gastroenterology. 2007;133:769–79.CrossRefPubMedGoogle Scholar
  20. 20.
    Bewtra M, Kilambi V, Fairchild AO, Siegel CA, Lewis JD, Johnson FR. Patient preferences for surgical versus medical therapy for ulcerative colitis. Inflamm Bowel Dis. 2014;20(1):103–14.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Sewell JL, Velayos FS. Systematic review: the role of race and socioeconomic factors in inflammatory bowel disease healthcare delivery and effectiveness. Inflamm Bowel Dis. 2013;19:627–43.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Nguyen GC, Bayless TM, Powe NR, Laveist TA, Brant SR. Race and health insurance are predictors of hospitalized Crohn’s disease patients undergoing bowel resection. Inflamm Bowel Dis. 2007;13:1408–16.CrossRefPubMedGoogle Scholar
  23. 23.
    Lin KK, Sewell JL. The effects of race and socioeconomic status on immunomodulator and anti-tumor necrosis factor use among ambulatory patients with inflammatory bowel disease in the United States. Am J Gastroenterol. 2013;108:1824–30.CrossRefPubMedGoogle Scholar
  24. 24.
    Nahon S, Lahmek P, Macaigne G, Faurel JP, Sass C, Howaizi M, et al. Socioeconomic deprivation does not influence the severity of Crohn’s disease: results of a prospective multicenter study. Inflamm Bowel Dis. 2009;15:594–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Zhang CK, Hewett J, Hemming J, Grant T, Zhao H, Abraham C, et al. The influence of depression on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;8:1732–9.Google Scholar
  26. 26.
    Fuller-Thomson E, Sulman J. Depression and inflammatory bowel disease: findings from two nationally representative Canadian surveys. Inflamm Bowel Dis. 2006;12:697–707.CrossRefPubMedGoogle Scholar
  27. 27.
    Nahon S, Lahmek P, Durance C. Risk factors of anxiety and depression in inflammatory bowel disease. Inflamm Bowel Dis. 2012;11:2086–91.CrossRefGoogle Scholar
  28. 28.
    Nahon S, Lahmek P, Saas C, Durance C, Olympie A, Lesgourgues B, et al. Socioeconomic and psychological factors associated with nonadherence to treatment of inflammatory bowel disease patients: results of the ISSEO study. Inflamm Bowel Dis. 2011;6:1270–6.CrossRefGoogle Scholar
  29. 29.
    Jackson CA. Factors associated with non-adherence to oral medications for inflammatory bowel disease: a systematic review. Am J Gastroenterol. 2010;105:525–39.CrossRefPubMedGoogle Scholar
  30. 30.
    Persoons P, Vermeire S, Demyttenaere K, Fischler B, Vandenberghe J, Van Oudenhove L, et al. The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Aliment Pharmacol Ther. 2005;22:101–10.CrossRefPubMedGoogle Scholar
  31. 31.
    Ananthakrishnan AN, Gainer VS, Perez RG, Cai T, Cheng SC, Savova G, et al. Psychiatric co-morbidity is associated with increased risk of surgery in Crohn’s disease. Aliment Pharmacol Ther. 2013;37:445–54.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Kane S, Huo D, Aikens J, Hanauer S. Medication non-adherence and the outcomes of patients with quiescent ulcerative colitis. Am J Med. 2003;114:39–43.CrossRefPubMedGoogle Scholar
  33. 33.
    Haynes RB, Taylor DW, Sackett DL, editors. Compliance in health care. Baltimore: Johns Hopkins University Press; 1979. p. 1–7.Google Scholar
  34. 34.
    Loftus EV Jr. A practical perspective on ulcerative colitis: patients’ needs from aminosalicylate therapies. Inflamm Bowel Dis. 2006;12:1107–13.CrossRefPubMedGoogle Scholar
  35. 35.
    Develen J, Beustevren K, Yen L, Ahmed A, Cheifetz AS, Moss AC. Barriers to mesalamine adherence in patients with inflammatory bowel disease: a qualitative analysis. J Manag Care Spec Pharm. 2014;20:309–14.Google Scholar
  36. 36.
    Kane SV, Accortt NA, Magowan S, Brixner D. Predictors of persistence with 5-aminosalicylic acid therapy for ulcerative colitis. Aliment Pharmacol Ther. 2009;29:855–62.CrossRefPubMedGoogle Scholar
  37. 37.
    Robinson A, Hankins M, Wiseman G, Jones M. Maintaining stable symptom control in inflammatory bowel disease: a retrospective analysis of adherence, medication switches, and risk of relapse. Aliment Pharmacol Ther. 2013;38:531–8.PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Bokemeyer B, Teml A, Roggel C, Hartmann P, Fischer C, Schaeffeler E, et al. Adherence to thiopurine treatment in outpatients with Crohn’s disease. Aliment Pharmacol Ther. 2007;26:217–55.CrossRefPubMedGoogle Scholar
  39. 39.
    Goodhand JR, Kamperidis N, Sirwan B, Macken L, Tshuma N, Koodun Y, et al. Factors associated with thiopurine non-adherence in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38:1097–108.CrossRefPubMedGoogle Scholar
  40. 40.
    Lopez A, Billioud V, Peyrin-Biroulet L. Adherence to anti-tumor necrosis factor therapy in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2013;19:1528–33.CrossRefPubMedGoogle Scholar
  41. 41.
    Kane S, Dixon L. Adherence rates with infliximab therapy in Crohn’s disease. Aliment Pharmacol Ther. 2006;24:1099–103.CrossRefPubMedGoogle Scholar
  42. 42.
    Kane SV, Chao J, Mulani PM. Adherence to infliximab maintenance therapy and health care utilization and costs by Crohn’s disease patients. Adv Ther. 2009;26:936–46.CrossRefPubMedGoogle Scholar
  43. 43.
    Gillespie D, Hood K, Farewell D, Stenson R, Probert C, Hawthorne AB. Electronic monitoring of medication adherence in a 1-year clinical study of 2 dosing regimens of mesalazine for adults in remission with ulcerative colitis. Inflamm Bowel Dis. 2014;20:82–91.CrossRefPubMedGoogle Scholar
  44. 44.
    Farraye FA, Odze RD, Eaden J, Itzkowitz SH. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138:746–74.CrossRefPubMedGoogle Scholar
  45. 45.
    Woolrich AJ, DaSilva MD, Korelitz BI. Surveillance in the routine management of ulcerative colitis: the predictive value of low-grade dysplasia. Gastroenterology. 1992;103:431–8.PubMedGoogle Scholar
  46. 46.
    Friedman S, Cheifetz AS, Farraye FA, Banks PA, Makrauer FL, Burakoff R, et al. Factors that affect adherence to surveillance colonoscopy in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:534–39.CrossRefPubMedGoogle Scholar
  47. 47.
    Wasan SK, Calderwood AH, Long MD, Kappelman MD, Sandler RS, Farraye FA. Immunization rates and vaccine beliefs among patients with inflammatory bowel disease: an opportunity for improvement. Inflamm Bowel Dis. 2014;20:246–50.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Sewitch MJ, Abrahamowicz M, Barkun A, Bitton A, Wild GE, Cohen A, et al. Patient nonadherence to medication in inflammatory bowel disease. Am J Gastroenterol. 2003;98:1535–44.CrossRefPubMedGoogle Scholar
  49. 49.
    Greenley RN, Kunz JH, Walter J, Hommel KA. Practical strategies for enhancing adherence to treatment regimens in inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:1534–45.PubMedCentralCrossRefPubMedGoogle Scholar
  50. 50.
    Martin A, Leone L, Castagliuolo J, Di Mario F, Naccarato R. What do patients want to know about their inflammatory bowel disease? Ital J Gastroenterol. 1992;24:477–80.PubMedGoogle Scholar
  51. 51.
    Waters BM, Jensen L, Fedorak R. Effects of formal education for patients with inflammatory bowel disease: a randomized controlled trial. Can J Gastroenterol. 2005;19:235–44.PubMedGoogle Scholar
  52. 52.
    Kane S, Huo D, Magnanti K. A pilot feasibility study of once daily versus conventional dosing mesalamine for maintenance of ulcerative colitis. Clin Gastroenterol Hepatol. 2003;1:170–3.CrossRefPubMedGoogle Scholar
  53. 53.
    Cross RK, Cheevers N, Rustgi A, Langenberg P, Finkelstein J. Randomized, controlled trial of home telemanagement in patients with ulcerative colitis (UC HAT). Inflamm Bowel Dis. 2012;18:1018–25.PubMedCentralCrossRefPubMedGoogle Scholar
  54. 54.
    Elkjaer M, Shuhaibar M, Burisch J, Bailey Y, Scherfig H, Laugesen B, et al. E-health empowers patients with ulcerative colitis: a randomized controlled trial of the web-guided ‘Constant-care’ approach. Gut. 2010;59:1652–61.CrossRefPubMedGoogle Scholar
  55. 55.
    Kane SV, Robinson A. Review article: understanding adherence to medication in ulcerative colitis—innovative thinking and evolving concepts. Aliment Pharmacol Ther. 2010;32:1051–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: The National Academies Press; 2001.Google Scholar
  57. 57.
    Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27:759–69.CrossRefGoogle Scholar
  58. 58.
    Donabedian A. The criteria and standards of quality. Ann Arbor: Health Administration Press; 1982.Google Scholar
  59. 59.
    Reddy SI, Friedman S, Telford JJ. Are patients with inflammatory bowel disease receiving optimal care? Am J Gastroenterol. 2005;100:1357–61.CrossRefPubMedGoogle Scholar
  60. 60.
    Melmed GY, Siegel CA, Brennan MS. Quality indicators for inflammatory bowel disease: development of process and outcome measures. Inflamm Bowel Dis. 2013;19:662–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Wasan SK, Baker SE, Skolnik PR, Farraye FA. A practical guide to vaccinating the inflammatory bowel disease patient. Am J Gastroenterol. 2010;105:1231–8.CrossRefPubMedGoogle Scholar
  62. 62.
    National Center for Immunization and Respiratory Diseases. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60:1–64.Google Scholar
  63. 63.
    Yeung JH, Goodman K, Fedorak RN. Inadequate knowledge of immunization guidelines: a missed opportunity for preventing infection in immunocompromised IBD patients. Inflamm Bowel Dis. 2011;18:34–40.CrossRefPubMedGoogle Scholar
  64. 64.
    Wasan SK, Coukos JA, Farraye FA. Vaccinating the inflammatory bowel disease patient: deficiencies in gastroenterologists knowledge. Inflamm Bowel Dis. 2011;17:2536–40.CrossRefPubMedGoogle Scholar
  65. 65.
    Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010;59:1102–6.Google Scholar
  66. 66.
    Bernstein CN, Leslie WD. Review article: osteoporosis and inflammatory bowel disease. Aliment Pharmacol Ther. 2004;19:941–52.CrossRefPubMedGoogle Scholar
  67. 67.
    Oostlander AE, Bravenboer N, Sohl E, Holzmann PJ, van der Woude CJ, Dijkstra G, et al. Histomorphometric analysis reveals reduced bone mass and bone formation in patients with quiescent Crohn’s disease. Gastroenterology. 2011;140:116–23.CrossRefPubMedGoogle Scholar
  68. 68.
    American Gastroenterological Association medical position statement: guidelines on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003;124:791–4.Google Scholar
  69. 69.
    Melek J, Sakuraba A. Efficacy and safety of medical therapy for low bone mineral density in patients with inflammatory bowel disease: a meta-analysis and systematic review. Clin Gastroenterol Hepatol. 2014;12:32–44.CrossRefPubMedGoogle Scholar
  70. 70.
    Siegel CA. Explaining risks of inflammatory bowel disease therapy to patients. Aliment Pharmacol Ther. 2011;33:23–32.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Gastroenterology, Hepatology and NutritionVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of Gastroenterology, Hepatology and Nutrition, Inflammatory Bowel Disease CenterVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations