Coping with the unmet needs of gastroenterology and hepatology outpatients: a systematic approach towards an integrated model of care in South Australia
Date
2011
Authors
Mikocka-Walus, A.A.
Turnbull, D.A.
Holtmann, G.
Andrews, J.M.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Conference item
Citation
Gastroenterology, 2011, vol.140, iss.5 Suppl. 1, pp.S-208-S-208
Statement of Responsibility
Antonina A. Mikocka-Walus, Deborah A. Turnbull, Gerald Holtmann, Jane M. Andrews
Conference Name
Digestive Disease Week (DDW) (7 May 2011 - 10 May 2011 : Chicago, IL)
Abstract
Background: Many patients with gastrointestinal and hepatologic conditions also suffer from mental health problems. Psychological co-morbidities are clearly associated with poor outcome and increased health care utilisation. An integrated model of care has been used with success in the management of irritable bowel syndrome but so far not routinely in other organic GI and hepatologic conditions. This paper aims to provide a summary of research conducted collaboratively by our team comprising psychologists, gastroenterologists, hepatologists and basic scientists in order to establish the biopsychosocial integrated model of care for GI and heaptology outpatients in South Australia. Methods: The model is being introduced in 3 stages: 1) Evaluation of the size of the problem (investigations into mental health problems, their treatment and relationship to disease course in gastroenterology outpatients) (completed); 2) Initial biopsychosocial interventions to contribute to manage- ment of gastroenterology and hepatology outpatients (in progress); 3) Testing the model: service delivery changes (in progress). To date, as part of the three stages, 3 RCTs, 5 prospective studies, 5 cross-sectional studies and 3 reviews (2 systematic reviews) have been completed. Results: High rates of anxiety and depressive symptoms (40% reported anxiety symptoms at baseline and 37% at 12 months and 17% reported depressive symptoms at baseline and 13% at 12 months) that are maintained over time were identified in gastroenterol- ogy outpatients. A significant relationship between anxiety and poorer QOL and increased likelihood of relapses of inflammatory bowel disease was observed (both p<.05). Patients with documented psychological co-morbidities were more likely to be hospitalised than those without the co-morbidity (OR=4.13, 95% CI: 1.25, 13.61). A trend towards reduction in stress and anxiety and improvement in QOL has been observed when cognitive-behavioural therapy (CBT) was provided to patients. A drop in the use of opiates (p=0.037) and hospitalisation rates (from 48% to 30%) as well as a trend towards reduction in the use of corticosteroids has been noted as a result of introduction of the changed model of care. Conclusions: 1) Our studies confirm a significant burden of psychological co-morbidity in GI and hepatology outpatients; 2) psychological co-morbidity is associated with a more severe clinical course of disease; 3) CBT appears to reduce stress and anxiety and improve QoL; 4) a more integrated model of care leads to improvement in patient outcomes. Our data suggest that the integrated model of care involving a significant nursing and psychological input might be cost saving if the overall health care costs per patient are considered even though this needs to be properly tested in future stage 2 and 3 studies.
School/Discipline
Dissertation Note
Provenance
Description
Access Status
Rights
© 2011 AGA. Published by Elsevier Inc. All rights reserved.