Optimizing quality of outpatient care for patients with inflammatory bowel disease: the importance of specialist clinics.

BACKGROUND: Most patients with inflammatory bowel disease (IBD) undergo long-term outpatient follow up. However, quality of care provided by specialist and non-specialist IBD clinics is rarely critically audited.
OBJECTIVE: To compare the standard of outpatient care provided by general gastroenterology and specialist IBD clinics within a single hospital using defined quality criteria.
METHODS: The case notes of 60 consecutive patients with IBD attending general gastroenterology clinics and of 100 patients attending the specialist IBD clinic were reviewed for fulfillment of six quality criteria over the preceding 18 months.
RESULTS: The proportion of patients fulfilling all six criteria was higher in the specialist IBD clinic. In the specialist IBD clinic, compared with the general gastroenterology clinics, blood tests were performed with appropriate frequency during the initiation of immunosuppressive treatment in 7/11 versus 2/12 patients (P=0.04) and during maintenance in 24/31 versus 6/21 patients (P=0.001); bone protection with oral steroids were given to 25/53 versus 4/24 patients (P=0.01); a screening colonoscopy at 8-10 years was performed in 25/27 versus 11/20 patients with ulcerative colitis (P=0.004); annual serum urea and creatinine concentrations were measured in 82/89 versus 31/45 patients prescribed 5-aminosalicylates (P=0.001); annual liver function tests were performed in 96/100 versus 38/60 patients (P=0.001); and annual haematinics were measured in 37/47 versus 18/33 patients with Crohn's disease (P=0.03).
CONCLUSION: By these criteria, the specialist IBD clinic provided better care than the non-specialist general gastroenterology clinics. Even in the specialist clinic, however, the care of a minority of patients did not fulfil certain criteria, emphasizing the need for a critical audit of outpatient management of IBD.