Retrospective Review on the implementation of Inflammatory Bowel Disease Preventative Care at Phoenix VA Hospital
Background:
Inflammatory bowel disease (IBD) patients are complex. Their health maintenance is co-managed by both the gastroenterologist and primary care team, especially those on immunomodulators or biologics. Prior studies have shown that IBD patients do not receive preventative care with the same diligence as the general population. As such, both ACG and Crohn’s & Colitis Foundation have a checklist that addresses vaccinations, screening, and other elements. Here, we assess the implementation of preventative care for the adult IBD patients at the Phoenix Veterans Affairs (VA) Hospital.
Methods:
We queried the National IBD medication monitoring report at the VA hospital, a pharmacy database that monitors all patients with ICD-9 or ICD-10 diagnosis of Crohn’s Disease (CD) or ulcerative colitis (UC) who were either seen or had active labs/medications at the VA in the past 18 months. Of the 915 IBD patients, we identified 211 individuals on biologic, immunomodulators, or synthetic small molecules. IRB approval was obtained.
Results:
Of the 211 individuals in our cohort, we identified 118, 89, 4 individuals with CD, UC, and IBD-unknown respectively. There were 184 males and 27 females. Average BMI was 29.47 (overweight), and average age was 59 years-old. There were 157 individuals who were Caucasians, 15 Hispanics, 14 African-Americans, 3 Asians, 1 American Indian or Alaska Native, 21 with unknown race. A total of 174 patients were on biologics, 50 on immunomodulators, and 10 on synthetic small molecules. The predominant biologic was adalimumab and immunomodulator was azathioprine. Extent of disease was documented in 76% of UC patients, and 91% of CD patients. There was a sparsity of documentation on varicella, HPV, MMR. 30% of individuals had at least one hepatitis A vaccine, 38% had at least one hepatitis B vaccine, 48% had at least one zoster recombinant, 49% had appropriate flu vaccination, 74% tetanus vaccination within 10 years, 78% had at least one Covid vaccine, and 77% had at least one pneumonia vaccine. 51% of individuals received a DEXA scan, with 18% having osteoporosis and 14 individuals who were on bisphosphonate. Additionally, 74% had colon cancer screening. Of the 27 females, only 25% had a yearly pap smear. Yearly eye exams were only documented in 25% of patients, and yearly skin exams occurred in 51%. Of the latter, 30% had skin cancer (basal cell carcinoma, squamous cell carcinoma, melanoma). Mental health was assessed in 31%, although 68 patients were already on treatment. 31% of all patients were not assessed for smoking. Finally, hepatitis B serologies were checked in 92% of patients. TB status was checked in 90%, and cocci in 64%. Yearly vitamin D level was evaluated in 75%, B12 in 53%, and iron panel in 33%.
Conclusions:
Preventative measures in patients with IBD are crucial in preventing disease and improving health. Our study demonstrated areas of improvement, specifically, with regards to yearly pap smears, skin exam, eye exam, mental health assessment, smoking assessment, and specific vaccines. This underscores the need for proactive preventative care and appropriate referral to consultants when treating IBD patients.
