Abstract
Abstract
Background
Patients with inflammatory bowel disease (IBD) require more frequent and varied screening tests in order to reduce patient morbidity and mortality. Beyond colonoscopies, routine skin, ophthalmologic, vitamin D, and DXA evaluations are recommended to reduce IBD complications. This study investigated the rates of health maintenance evaluations in IBD patients and whether demographics impacted patient management in a university medical center.
Methods
A retrospective chart review evaluating all IBD patients seen at a university gastroenterology clinic over a five-year period was performed. Patient gender, self-categorized race, IBD diagnosis and whether the patient was recommended to get bone (DXA, vitamin D), dermatologic or ophthalmologic evaluations were noted. A database was created using Microsoft Excel. Statistical analysis was performed using a two-tailed Fisher’s Exact Test with significance set at P<0.05. The study was approved by the IRB.
Results
Medical records of 393 patients (218 female, 175 male) were reviewed. 279 (71.0%) had ulcerative colitis, 96 (24.4%) had Crohn’s disease, 7 (1.8%) had indeterminate colitis, and 11 (2.8%) had microscopic colitis. 249 (63.4%) had vitamin D levels, 110 (28%) had DXA, 125 (31.8%) had ophthalmologic exams and 83 (21.1%) had skin evaluations. Women received significantly more DXA scans (p=0.007) and vitamin D testing (p=0.049) compared to men. There were no significant differences in performance of skin exams and recommendations (p=0.71) or ophthalmologic exams (p=0.66) between women and men. 204 patients (51.9%) were Caucasian, 100 (29.0%) were African American, 12 (3.1%) were Asian, and 77 (19.6%) were unspecified race. There were no significant differences in vitamin D surveillance in Caucasians with African Americans (p=0.092) or Asians (p=1). There were no significant differences in DXA scans between Caucasians and African Americans (p=0.121) or Asians (p=0.152). On the other hand, skin exams were performed at significantly higher rates in Caucasians compared to African Americans (p<0.0001) and Asians (p<0.0001), as was ophthalmologic screening among Caucasians relative to African Americans (p<0.0001) and Asians (p<0.0001).
Discussion
This study revealed that there was inconsistent adherence to IBD health maintenance recommendations. Women received significantly more testing for bone health compared to men. There was no difference in skin exams and ophthalmologic exams based upon patient gender. Notably, Caucasian patients received significantly more ophthalmologic and skin exams compared to patients of other races. While this study is limited based upon retrospective and single institution design, this study supports recommendations for increased efforts to improve health maintenance recommendations among all patients to optimize clinical outcomes.