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Health Care Services in IBD: Factors Associated with Service Utilization and Preferences for Service Options for Routine and Urgent Care

Bernstein, Matthew T. MA*,†; Walker, John R. PhD*,‡; Chhibba, Tarun BSc*; Ivekovic, Melony BA*; Singh, Harminder MD, MPH*,§; Targownik, Laura E. MD, MSHS*,§; Bernstein, Charles N. MD*,§

doi: 10.1097/MIB.0000000000001215
IBD LIVE Article

Background: We aimed to explore factors associated with health service utilization and preference for services, including alternatives to attending the emergency department (ED) when experiencing mild to moderate or severe symptoms.

Methods: A total of 1143 persons (46% response rate) aged 18 to 65 years in the population-based University of Manitoba IBD Research Registry participated in the survey.

Results: Although 61% had a gastroenterologist, when experiencing active symptoms, only 29% felt they could call their gastroenterologist for an urgent appointment, and 42% could call their gastroenterologist for telephone advice. Nine percent of the respondents visited the ED in the previous year. If having severe symptoms, 48% said that they would attend the ED. Visits to the ED were related to higher bowel symptom severity and high health anxiety. When experiencing severe symptoms, women, persons with Crohn's disease and those with high health anxiety, indicated that they would be more likely to use the ED. Considering services which could be available in the future respondents indicated that if acutely symptomatic they would be very likely or likely to use the following services: phone contact with inflammatory bowel disease nurse (77%), phone contact with a gastroenterologist (75%), and going to a walk-in gastroenterology clinic (71%).

Conclusions: Persons with inflammatory bowel disease are receptive to options other than the ED when experiencing inflammatory bowel disease symptoms; however, attending the ED remains a prominent choice. Improved access to specialized care may improve timeliness of care and reduce ED attendance. Future research should include the impact of health anxiety on health care utilization.

Article first published online 10 August 2017.

*Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada; and

Departments of Psychology,

Clinical Health Psychology, and

§Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

Address correspondence to: Matthew T. Bernstein, MA, IBD Clinical and Research Centre, University of Manitoba, MS-781-820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada (e-mail: umbernsm@myumanitoba.ca).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).

This study was funded by AbbVie Canada. The sponsor did not have a role in study design or in the collection, analysis, and interpretation of data. Dr. Charles Bernstein is supported by the Bingham Chair in Gastroenterology.

C. N. Bernstein: advisory boards for AbbVie Canada, Janssen Canada, Shire Canada, Takeda Canada, Pfizer, Cubist Pharmaceuticals, and Napo Pharmaceuticals; consultant to Mylan Pharmaceuticals; educational grants from AbbVie Canada, Shire Canada, Takeda Canada, and Janssen Canada; speaker's panel for AbbVie Canada, Ferring Canada, and Shire Canada; and received research funding from AbbVie Canada. H. Singh: advisory boards for Pendopharm and Ferring Canada and received research funding from Merck Canada. L. E. Targownik: speaker's panel for Janssen Canada, Takeda Canada, and Pfizer Canada and advisory boards for Takeda Canada, AbbVie Canada, and Janssen Canada. The remaining authors have no conflict of interest to disclose.

Received May 11, 2017

Accepted May 31, 2017

© Crohn's & Colitis Foundation
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