Assessing Attitudes, Access, Barriers, and Facilitators to Multidisciplinary Care in Pediatric Inflammatory Bowel Disease

Background:
Inflammatory bowel disease (IBD) is a chronic immune-mediated condition that impacts the psychosocial health and quality of life of patients, in addition to their physical health. Multidisciplinary care is recommended in the care of children and adolescents with IBD. Multidisciplinary care models for pediatric IBD have been described in the literature although provider attitudes and perceived barriers and facilitators to multidisciplinary care remain largely unknown. These factors are essential to understanding multidisciplinary care accessibility. This study aims to 1) describe provider attitudes, barriers, and facilitators regarding multidisciplinary care in pediatric IBD, and 2) explore associations between access to multidisciplinary care and center-level factors.
Methods:
This is a cross-sectional survey of pediatric gastroenterology medical (GI) providers (physicians and advanced practice providers) who practice at centers registered with the ImproveCareNow (ICN) network in the United States (US). Providers outside of these centers and non-medical providers were excluded. Participants were electronically consented and completed the survey via REDCap. Respondents provided demographic information, ICN center role information (e.g., ICN site lead), as well as objective and subjective questions regarding their center’s current multidisciplinary care approach. Descriptive statistics were used to summarize data.
Results:
Sixty-nine medical providers across 55 ICN centers (56% of US ICN centers) were successfully recruited, including 54 ICN center leads (42% of center leads). Participating centers had an average of 14 GI physicians (standard deviation 11) per division. Roughly half (54%) of respondents considered their position to be primarily IBD-focused. The most common multidisciplinary IBD team members reported by center leads included nurses (94%), dietitians (93%), nurse practitioners (63%), social workers (63%), psychologists (61%), research coordinators (57%), and prior authorization specialists/biologic navigators (52%). Center leads reported that their teams provided IBD care via telehealth (93%), standardized educational materials (85%), multidisciplinary visits (67%), new diagnosis educational processes (65%), and a transition program to adult care (63%); less than half of centers offered IBD support groups for parents/caregivers (43%) or patients (37%). All participants (100%) surveyed felt that multidisciplinary care was beneficial for IBD patients, with nearly all participants (97%) endorsing that it is helpful to have access to multidisciplinary providers during clinic. Participants endorsed various barriers to multidisciplinary care, including lack of support from institutional leadership (81%), limited access to multidisciplinary providers (81%), and/or securing adequate numbers of providers to meet clinical demand (86%). Most participants also felt that multidisciplinary care should be standard for care for IBD (81%) and that patients/families desired this type of care (80%).
Conclusions:
Pediatric GI providers have positive attitudes regarding IBD multidisciplinary care and perceive this care as important and desired by their patients/caregivers. Current access is variable and sometimes absent across US ICN centers. Reported barriers exist, primarily at the system-level. Future work should seek to further understand and address system-level barriers, as well as continued understanding of the short and long-term benefits of multidisciplinary care in pediatric IBD.