The latest national IBD audit reports, published 25 September 2014, address the provision of IBD services and management of biological therapies for adult and paediatric patients.
Key findings
The UK IBD audit programme is calling for an NHS national strategy for IBD in order for national healthcare decision makers, doctors, nurses and patient groups to better prioritise care for patients with IBD. Evidence from the audit highlights the need for a national strategy to make sure IBD services in England and Wales are the best they can be for patients.
The results of these reports show a varied picture of service provision for patients with IBD in the UK. In order to enable services to deliver high-quality care, the UK IBD audit is calling for greater prioritisation of IBD care among national decision makers, to support the clinical teams treating patients with this chronic condition. These findings further support UK IBD audit reports published earlier in 2014 about inpatient care and patient experience.
Data from the audit suggest some admissions to hospital could have been prevented if patients’ symptoms had been picked up sooner and treatment had started earlier. Standard treatments were not started or escalated in 42% (556/1329) of adult cases and 54% (56/103) of paediatric cases prior to admission to hospital.
The patients surveyed through the inpatient experience questionnaire had a variety of experiences before being admitted to hospital. Some patients reported being turned away from emergency departments only to be admitted to hospital in a worse condition two weeks later, which resulted in surgery. Other patients commented on healthcare staff not being knowledgeable enough about IBD and specialist medicines in order to be treated effectively.
However, substantive improvements have been made in IBD care since the previous round of the audit. The rate of mortality has decreased from 1.5% to 0.75%. More adult patients (74%) are being prescribed bone protection medication for the prevention of osteoporosis (a side effect of steroids patients take to manage IBD). Preventative anticoagulants are given to 90% of adult patients (an increase from 70%) with only 1% of clotting complications. Colitis activity in paediatric patients is now recorded in hospital much more closely and Clostridium difficile (C diff) testing was recorded in 66% of paediatric patients (an increase from 36%).
In summary, the reports show that patients are experiencing differences in the quality of care and treatment they receive for ulcerative colitis (UC).
The reports make recommendations for doctors, nurses and multidisciplinary teams caring for both adult and paediatric patients with IBD, including:
- Patients should receive an accurate assessment of disease activity and treatment should be given to people with active disease.
- All patients admitted to hospital should have their nutritional needs assessed using a nutritional screening tool.
- Anaemia (low iron levels in the blood) is common among IBD patients and should be actively investigated and treated with appropriate iron therapy.