Crohn's and Colitis - care improving but services fall short in key areas, UK IBD audit finds
21 February 2012
UK Inflammatory Bowel Disease Audit news release
The third round of the UK Inflammatory Bowel Disease Audit, carried out in 2010, shows that care for patients with ulcerative colitis (UC) and Crohn's disease (CD) has improved across a wide range of measures since the previous two rounds in 2006 and 2008.
- Mortality for patients admitted with Ulcerative Colitis (UC) has halved over the 3 rounds of the audit
- Readmission rates have lowered
- The percentage of patients being seen by an IBD Nurse Specialist during their admission has doubled since the first round
There is however still room for improvement, particularly in the following areas:
- More patients need to be tested for infections, including Clostridium Difficile (CDiff)
- All patients should be given heparin where appropriate to prevent blood clots
- More patients should see a specialist IBD nurse during their stay in hospital, who can advise and screen patients if anti-inflammatory treatment (Anti-TNF) is prescribed
- All Crohn's Disease patients should see a dietician to prevent malnutrition
- Patients should receive more help to give up smoking and stay stopped to prevent the risk of worse outcomes
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Inflammatory Bowel Disease is increasing and now affects one in 200 people in the UK, with profound life changing effects. The total cost of IBD to the NHS was estimated at £720 million in 2006.
The UK IBD Audit (2010) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) with additional funding from Healthcare Improvement Scotland.
The audit is co-ordinated by the Clinical Effectiveness and Evaluation unit (CEEu) of the Royal College of Physicians of London on behalf of a collaborative partnership between gastroenterologists (the British Society of Gastroenterology), colorectal surgeons (the Association of Coloproctology of Great Britain and Ireland), patients (Crohn's and Colitis UK), physicians (the Royal College of Physicians of London) and paediatric gastroenterologists (The British Society of Paediatric Gastroenterology, Hepatology and Nutrition).
The 2010 audit covered over 3,000 patients admitted with each condition. When comparing results from hospitals who participated in the previous two audits, 2,000 admissions each for UC and CD were directly comparable and their data is used here:
Ulcerative Colitis key findings:
- The amount of people dying from UC has reduced by half since 2006 (1.7% to 0.8%)
- The percentage of people admitted to hospital in the two years before the audited admission has reduced from 51% to 34%, most likely as a result of more responsive outpatient services
- Stool samples are now being sent significantly more frequently for both Standard Stool Cultures (SSC), (66% to 81%) and Clostridium Difficile Toxin (CDT), (54% to 75%) for UC patients admitted with diarrhoea
- There has been a significant reduction in the number of stool samples positive for CDT (4.2% to 1.6%) for patients admitted with diarrhoea in 2010.
- Prophylactic Heparin is being prescribed more frequently (54% to 87%). 2% (66/3049) of patients had a blood clot during their admission in the third round
- The prescription of bone protection for patients discharged on steroids has increased (41% to 70%) as recommended in the BSG Guidelines for the management of IBD in adults.
Crohn's Disease key findings:
- The use of Anti-TNF therapy for patients admitted with Crohn's Disease has doubled over 3 rounds but use remains at a relatively low level overall (3.9% to 8%)
- For Crohn's Disease there has not been the same increase as observed for Ulcerative Colitis in the rates of stool samples sent for Standard Stool Cultures and Clostridium Difficile Toxin in patients admitted with diarrhoea, in fact the rates increased between rounds 1 and 2 and decreased in round 3
- 34.7% of patients with IBD were taking 5-ASA (anti-inflammatory) drugs, but these are only effective in Ulcerative Colitis, not Crohn's Disease
- 63.3% of patients in 2010 (1978/3122) were not taking any form of immuno-suppressive drugs on admission, so are missing an important form of treatment
- Significantly more patients are being weighed during their admission (51.4% to 74.7%)
- The number of patients seen by a dietician during their admission has continued to rise across rounds but remains at a low rate overall (35.8% to 39.7%)
- Just under a third of patients with Crohn's Disease admitted to hospital are smokers. This has not changed over the 3 rounds of the IBD Audit (31.5% to 31%).
Dr Ian Arnott, Consultant Gastroenterologist, Western General Hospital and UK IBD Audit Clinical Lead, said: "The third round of the UK IBD audit has demonstrated very significant improvement in the care of IBD patients. The audit is widely supported by clinicians from around the UK and clinical teams have worked hard to realise these gains. Further rounds of the audit are needed to encourage and promote further improvement in the quality of care for patients with IBD."
Dr Kevin Stewart, Clinical Director of the Royal College of Physicians Clinical Effectiveness & Evaluation Unit, said:"This is really good news for patients with IBD: their care has improved right across the country. Care which is better coordinated and supported by specialised teams means that patients suffer less complications and spend less time in hospital. It is an example of what can be achieved when clinical teams and patient groups work in partnership. Of course we know that there are still problems, but I'm confident that we will address these in future rounds of the audit".
Mr Graeme Wilson, Consultant Surgeon and ACPGBI representative on the UK IBD Audit said: "The third round of the Audit continues to show marked improvements in the quality of care for patients with IBD in the U.K. Notable surgical changes compared to the previous years include the increased percentage of patients cared for by a specialist in coloproctology and a significant increase in the use of" keyhole" surgery particularly for elective cases. There is nonetheless still a need to keep up the momentum with further rounds of the audit focussing on areas where quality are could be improved."
Mr Richard Driscoll, Chief Executive, Crohn's and Colitis UK, said: "Patients who have Crohn's Disease or Ulcerative Colitis will be pleased to see that services and care for inflammatory bowel disease have continued to improve. An important step forward is that people will now be able to access some of the key information about the IBD Services provided by individual hospitals from the NHS Choices website. This will show whether hospitals are meeting the national IBD Standards in key areas, for example whether they have a dedicated gastroenterology ward or a specialist Inflammatory Bowel Disease nurse."
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