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A national care outline for IBD

Health professionals are calling for the development of a national approach for the care and treatment of patients with Inflammatory Bowel Disease (IBD). By Amie Larter

Crohn’s disease and ulcerative colitis, recognised collectively as IBD, currently affects 75,000 Australians and projections estimate this will spike to 100,000 in the next few years.

According to Crohn’s and Colitis Australia, the economic burden of the disease reaches $2.7 billion annually, and loss of productivity – including absenteeism, early retirement and premature death – accounts for more than half of the $500 million financial loss.

The disease impacts significantly on an individual’s ability to perform in everyday social and working situations, and the physical burden can be compared to someone living with rheumatoid arthritis, severe asthma or arm amputation.

If diagnosed and treated correctly at early stages, patients see good outcomes with minimal impact on quality of life.

However, if the disease is managed poorly however, uncontrolled inflammation can lead to complications such as bowel obstructions, abscesses and in more serious cases, bowel perforations.

A PricewaterhouseCoopers report, released at Parliament in Canberra on the 27 May, highlights the need for a national approach to care.

Dr Gregory Moore, head of Inflammatory Bowel Diseases, Gastroenterology & Hepatology Unit at Monash Medical Centre as well as senior lecturer, Department of Medicine, Monash University, agrees. He calls the current model “reactionary” and limited by “poor access to specialist care”.
He said that while prevalence of the disease is increasing, GPs still have very few patients with IBD and treatment is therefore not consistent.

He calls for further funding for specialist IBD nurses, who have proven an effective – both in performance and cost – for the delivery of care for this chronic condition.

“Raising awareness, empowering patients and providing reliable and continuing funding for IBD nurses is the most cost effective way to streamline the delivery of the complex care needs of IBD patients to reduce the chances of having adverse outcomes and impaired lives,” Moore said.

According to Moore, medical centres with a dedicated IBD clinic, IBD nurse and help line, the number of emergency presentations decrease and the hospital length of stay is also significantly shorter.

“IBD nurses, in consultation with the centre's IBD specialists help in coordinating the assessment process of complex drugs such as TNF inhibitors, monitoring blood tests for safety of immune-suppressives, instituting appropriate therapy such as dose escalation of existing medications like mesalasine during a flare or commencing suppositories or enemas.”

Specialist IBD nurses also excel in educating and supporting patients, prioritising appointments, coordinating monitoring tests and improving patient adherence.

Characterised by chronic abdominal pain, inflammatory bowel disease is a functional bowel disorder that has no single cause. It’s effectively a collection of disorders that can include constipation and painful diarrhea as symptoms, with additional bloating and general pain, and may be triggered by a variety of other, similar conditions.

It can also present with gastroesophageal reflux, incomplete evacuation of the bowel, and, because of symptomatic similarities to other syndromes and illnesses, is often misdiagnosed.

Doctors recommend that those who have been diagnosed with IBD are checked for allergies and intolerances for lactose and fructose malabsorption; however, attempts to test for a relationship to food sensitivity have not yielded conclusive results.

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