Benefits of implementing a rapid access clinic in a high-volume inflammatory bowel disease center: Access, resource utilization and outcomes.

BACKGROUND: Emergency situations in inflammatory bowel diseases (IBD) put significant burden on both the patient and the healthcare system. AIM: To prospectively measure Quality-of-Care indicators and resource utilization after the implementation of the new rapid access clinic service (RAC) at a tertiary IBD center. METHODS: Patient access, resource utilization and outcome parameters were collected from consecutive patients contacting the RAC between July 2017 and March 2019 in this observational study. For comparing resource utilization and healthcare costs, emergency department (ED) visits of IBD patients with no access to RAC services were evaluated between January 2018 and January 2019. Time to appointment, diagnostic methods, change in medical therapy, unplanned ED visits, hospitalizations and surgical admissions were calculated and compared. RESULTS: 488 patients (Crohn's disease: 68.4%/ulcerative colitis: 31.6%) contacted the RAC with a valid medical reason. Median time to visit with an IBD specialist following the index contact was 2 d. Patients had objective clinical and laboratory assessment (C-reactive protein and fecal calprotectin in 91% and 73%). Fast-track colonoscopy/sigmoidoscopy was performed in 24.6% of the patients, while computed tomography/magnetic resonance imaging in only 8.1%. Medical therapy was changed in 54.4%. ED visits within 30 d following the RAC visit occurred in 8.8% (unplanned ED visit rate: 5.9%). Diagnostic procedures and resource utilization at the ED (n = 135 patients) were substantially different compared to RAC users: Abdominal computed tomography was more frequent (65.7%, P < 0.001), coupled with multiple specialist consults, more frequent hospital admission (P < 0.001), higher steroid initiation (P < 0.001). Average medical cost estimates of diagnostic procedures and services per patient was $403 CAD vs $1885 CAD comparing all RAC and ED visits. CONCLUSION: Implementation of a RAC improved patient care by facilitating easier access to IBD specific medical care, optimized resource utilization and helped avoiding ED visits and subsequent hospitalizations.

Perceived Quality of Care is Associated with Disease Activity, Quality of Life, Work Productivity, and Gender, but not Disease Phenotype: A Prospective Study in a High-volume IBD Centre.

BACKGROUND AND AIMS: Measuring quality of care [QoC] in inflammatory bowel diseases [IBD] has become increasingly important, yet complex assessment of QoC from the patients' perspective is rare. We evaluated perceived QoC using the Quality of Care Through the Patient's Eyes-IBD [QUOTE-IBD] questionnaire, and investigated associations between QoC, disease phenotype, work productivity, and health-related quality of life [HRQoL] in a high-volume IBD centre. METHODS: Consecutive patients attending McGill University Health Centre [MUHC]-IBD Centre completed the QUOTE-IBD, Short Inflammatory Bowel Disease Questionnaire [SIBDQ], IBD-Control, and Work Productivity and Activity Impairment [WPAI] questionnaires. The QUOTE-IBD comprises 23 questions, each rated by a quality impact [QI] score. QI scores were calculated for the evaluation of IBD specialists, general practitioners [GPs], and hospital care. RESULTS: In all, 525 patients completed the questionnaire. Total QI scores for IBD specialists, GPs, and hospital care were 8.57, 8.70, and 8.33, respectively. The lowest QI scores were related to 'accessibility' for both IBD specialists and GPs. Female gender, current disease activity, poor HRQoL [SIBDQ score ≤50], and poor disease control [IBD-Control score <13] were associated with lower mean QI scores [p <0.001 for all]. Disease phenotype was not associated with QI scores in either Crohn's disease [CD] or ulcerative colitis [UC] [p = 0.69, p = 0.791, respectively]. An inverse correlation was found between total QI scores and work productivity loss [IBD specialist: p <0.001; GP: p = 0.004]. CONCLUSIONS: Overall patient satisfaction with QoC was good; however, improving patient accessibility to care is warranted. Disease phenotype was not associated with patient satisfaction, whereas female gender, current disease activity, HRQoL, and work productivity loss were associated with patients' quality assessment, underlining that perceived QoC could be partly subjective regarding disease control and quality of life.

El orden Carnivora (Mammalia) en el Perú: Estado del conocimiento y prioridades de investigación para su conservación / The order Carnivora (Mammalia) in Peru: State of Knowledge and research priorities for its conservation

La alta diversidad de especies de carnívoros del Perú puede generar problemas al momento de decidir los taxa y temas sobre los que deben dirigirse los esfuerzos de investigación. En este trabajo se evalúa el esfuerzo de investigación en base al número de publicaciones realizadas para cada familia y especie de carnívoro en el Perú. Asimismo, se señalan los vacíos de información relevantes para la conservación de cada especie y se presenta la primera evaluación de las prioridades de investigación sobre este grupo animal en el Perú. Se registró 145 publicaciones sobre carnívoros peruanos realizadas desde el año 1943. El número de publicaciones presentó grandes diferencias entre taxa, entre temas estudiados y entre las ecorregiones en las que se realizaron las investigaciones. Según la escala de prioridades propuesta, la especie que debe ser estudiada con mayor prioridad es el coatí andino Nasua olivacea y la de menor prioridad es el ocelote Leopardus pardalis. Los resultados de nuestro trabajo resaltan la urgencia de realizar investigaciones sobre ciertas especies de carnívoros de las que existen pocos datos publicados, tanto a nivel local como global, y que se distribuyen en pocas ecorregiones del Perú. Tanto la escala de prioridades de investigación como la lista de vacíos de información serán de utilidad para guiar esfuerzos logísticos y financieros de investigadores particulares, instituciones privadas y gubernamentales.

The high diversity of Peruvian carnivore species may pose problems when deciding to which taxa and topics new research efforts should be directed. In this publication, we evaluated the research effort made on each taxa -by assessing the number of publications per species-, point out the knowledge gaps that are important to the conservation of each species and present the first evaluation of research priorities for this group of animals to the country. We registered 145 publications about Peruvian carnivores made since 1943. The number of publications is significantly different between taxa, between subjects and between ecoregions where the research was conducted. According to the proposed priority scale, the species to be studied with greater priority is Nasua olivacea and the lowest priority is for Leopardus pardalis. The results of our study highlight the urgent need to conduct research on certain species of carnivores about which there are few published data, locally and globally, and which occupy a low number of ecoregions in the country. Both the scale of research priorities and the list of knowledge gaps presented here will be useful to guide logistical and financial efforts, for individual researchers as well as for private or governmental institutions.