Restoration of quality of life of patients with inflammatory bowel disease after one year with antiTNFα treatment.

BACKGROUND: Inflammatory bowel disease impairs patients' health related quality of life (HRQOL). AntiTNFα agents control disease activity effectively. An ambitious goal of treatment is to achieve the normalization of health. This can be assessed by using a cut-off scoring threshold of the IBDQ-36 questionnaire. It has not been established if antiTNFα treatment is able to restore to normal patients' HRQOL. AIMS: To determine whether patients with Crohn's disease (CD) and ulcerative colitis (UC) in clinical remission after one year treatment with antiTNFα agents achieve normalization of their HRQOL. METHODS: Observational and cross-sectional study in patients treated with antiTNFα for one year and in sustained clinical remission. Patients completed the specific questionnaire IBDQ-36. Complete restoration of health was considered achieved when global score of IBDQ-36 was higher than 209 points. RESULTS: 54 patients (43 with CD and 11 with UC) were included. Thirty patients received adalimumab and 24 infliximab. Median global score of the IBDQ-36 was 231, without differences between CD and UC (228 vs 235 respectively, p=ns). Normalization of HRQOL was achieved in all 11 UC patients and in 29 out of 43 CD patients (67%). In our sample population, restoration of health was significantly more frequent in UC than in CD (p<0.05). CONCLUSIONS: One-year clinical remission induced by antiTNFα treatment restores perception of health to normal in most patients with IBD.

Effect upon hospital activity of the application of a continued care model centered on patients with inflammatory bowel disease.

BACKGROUND: Since 1999, the Crohn-Colitis Care Unit (UACC) has been dedicated to the integral management of patients with Crohn´s disease (CD) and ulcerative colitis (UC). The working methodology of the UACC is based on personalized, continued, nonphysical presence, open access and patient-centered care. From its creation, the UACC has experienced an increase in the number of its users and outpatient services. However, the impact of the activity of the UACC upon patient hospitalization is not known. OBJECTIVES: To determine the hospital activity related to CD and UC, and correlate it to the activity of the UACC. METHODS: A retrospective evaluation was made of the physical presence and non-presence activities of the UACC from January 1999 to December 2008, and of the hospital admissions and mean durations of stay due to CD and UC during that same time period. RESULTS: The number of attended patients and of presence and non-presence activities of the UACC has gradually increased. This increase contrasts with the number of annual hospital admissions, which has remained stable during the study period, with 200-300 admissions/year. Consequently, the hospitalized patients / UACC registered patients ratio has decreased from 0.36 at the start of the study period to 0.14 at the end. The median hospital stay has also decreased, from 11 days at the start of the study period to 8 days at the end. CONCLUSIONS: The UACC allows effective management of IBD patient care, since it is able to attend the needs of more patients without increasing the number of admissions, and shortening the duration of hospital stay.

Efecto de la aplicación de un modelo de asistencia continuada centrada en el paciente con enfermedad inflamatoria intestinal en la actividad hospitalaria / Effect upon hospital activity of the application of a continued care model centered on patients with inflammatory bowel disease

Introducción: desde 1999 está en funcionamiento la Unidad de Atención Crohn-Colitis (UACC) para la atención integral a los pacientes con enfermedad de Crohn (EC) y colitis ulcerosa (CU). La UACC sigue un método de trabajo basado en la atención personalizada, continuada, no presencial, de acceso abierto y centrada en el paciente. Desde su implantación, la UACC se ha relacionado con un aumento en el número de usuarios y de actividades. Se desconoce, sin embargo, la repercusión que tiene el funcionamiento UACC sobre la hospitalización de los pacientes. Objetivos: determinar la actividad hospitalaria relacionada con la EC y la CU y su relación con la actividad desarrollada en la UACC. Métodos: revisión de la actividad desarrollada en la UACC desde enero de 1999 a diciembre de 2008, y de los ingresos hospitalarios y estancias medias hospitalarias por EC y CU en el mismo período. Resultados: el número de usuarios y de actividades prestadas en la UACC, ha aumentado de forma progresiva. Dicho incremento contrasta con el número anual de ingresos hospitalarios, que ha permanecido estacionario en 200-300 ingresos/año. En consecuencia, la ratio pacientes hospitalizados/pacientes registrados en la UACC ha disminuido de 0,36 a 0,14. La estancia media hospitalaria también se ha reducido, de 11 días a 8 días al final del periodo de observación. Conclusiones: el modelo UACC permite una gestión más eficaz de atención a los pacientes con EII ya que consigue atender las necesidades de más pacientes, sin aumentar el número de ingresos y acortando las estancias hospitalarias(AU)

Background: since 1999, the Crohn-Colitis Care Unit (UACC) has been dedicated to the integral management of patients with Crohn’s disease (CD) and ulcerative colitis (UC). The working methodology of the UACC is based on personalized, continued, nonphysical presence, open access and patient-centered care. From its creation, the UACC has experienced an increase in the number of its users and outpatient services. However, the impact of the activity of the UACC upon patient hospitalization is not known. Objectives: to determine the hospital activity related to CD and UC, and correlate it to the activity of the UACC. Methods: a retrospective evaluation was made of the physical presence and non-presence activities of the UACC from January 1999 to December 2008, and of the hospital admissions and mean durations of stay due to CD and UC during that same time period. Results: the number of attended patients and of presence and non-presence activities of the UACC has gradually increased. This increase contrasts with the number of annual hospital admissions, which has remained stable during the study period, with 200-300 admissions/year. Consequently, the hospitalized patients / UACC registered patients ratio has decreased from 0.36 at the start of the study period to 0.14 at the end. The median hospital stay has also decreased, from 11 days at the start of the study period to 8 days at the end. Conclusions: the UACC allows effective management of IBD patient care, since it is able to attend the needs of more patients without increasing the number of admissions, and shortening the duration of hospital stay(AU)

Validation of the Spanish version of a questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease (QUOTE-IBD).

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are chronic immunoinflammatory diseases that place a considerable burden on patients, their families, and society. Quality of care plays an important role for patients. A questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease (QUOTE-IBD) has been designed and validated specifically for the English language and culture. The objective was to translate the QUOTE-IBD into Spanish and to determine its validity in patients with IBD. METHODS: This is a prospective study in 2 phases: first, translation and validation of the Spanish QUOTE-IBD. Translation was based on the validated QUOTE-IBD. Second, once the complete translation was finished, comprehension of the items was assessed with a specific questionnaire in a reduced number of patients. Criterion validity was assessed with the Pearson's correlation coefficient between scores of the QUOTE-IBD and visual analog scales (VAS). In order to analyze the reproducibility of the Spanish QUOTE-IBD, the questionnaire was completed by stable patients twice, with a span of time of at least 4 weeks. RESULTS: A total of 103 patients (CD: 61, UC: 42) were included in the study. Pearson's correlation coefficient between total care Spanish QUOTE-IBD and VAS of health care items was 0.34 (P < 0.001). Correlations among all 6 care dimensions score of Spanish QUOTE-IBD and VAS were statistically significant (P < 0.01). Results of first and second administration of total care and dimensional care scores of Spanish QUOTE-IBD in 46 stable patients were not different. CONCLUSIONS: The Spanish QUOTE-IBD has proved to be a valid instrument to measure the quality of health care for patients with CD and UC.