Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
Clin Gastroenterol Hepatol. 2022 Aug;20(8):1831-1838. doi: 10.1016/j.cgh.2021.11.013. Epub 2021 Nov 16.
BACKGROUND & AIMS: Integrated inflammatory bowel disease (IBD) care is effective but not routinely implemented. Validated methods that simultaneously address mind and body targets such as resilience may improve access and outcomes. We describe the development and implementation of the GRITT method and its impact on resilience, health care utilization (HCU), and opioid use in IBD.
Consecutive patients from an academic IBD center were evaluated for low resilience on the basis of provider referral. Low resilience patients were invited to participate in the GRITT program. Primary outcome was % reduction in HCU. Secondary outcomes were change in resilience and corticosteroid and opioid use. Patients were allocated into 2 groups for analysis: GRITT participants (GP) and non-participants (NP). Clinical data and HCU in the year before enrollment were collected at baseline and 12 months. One-way repeated measures multivariate analysis of covariance evaluated group × time interactions for the primary outcome. Effect size was calculated for changes in resilience over time.
Of 456 screened IBD patients 394 were eligible, 184 GP and 210 NP. GP had greater reduction in HCU than NP: 71% reduction in emergency department visits, 94% reduction in unplanned hospitalizations. There was 49% reduction in opioid use and 73% reduction in corticosteroid use in GP. Resilience increased by 27.3 points (59%), yielding a large effect size (d = 2.4).
Mind-body care that focuses on building resilience in the context of IBD care may be a novel approach to reduce unplanned HCU and opioid use, but large, multicenter, randomized controlled trials are needed.
综合炎症性肠病（IBD）护理是有效的，但尚未常规实施。验证的方法，同时解决思维和身体目标，如韧性，可能会改善获得和结果。我们描述了 GRITT 方法的开发和实施及其对 IBD 患者韧性、医疗保健利用率（HCU）和阿片类药物使用的影响。
根据提供者的转介，对来自学术 IBD 中心的连续患者进行低韧性评估。低韧性患者被邀请参加 GRITT 计划。主要结果是 HCU 的减少百分比。次要结果是韧性的变化以及皮质类固醇和阿片类药物的使用。将患者分为 2 组进行分析：GRITT 参与者（GP）和非参与者（NP）。在基线和 12 个月时收集临床数据和入组前一年的 HCU。单向重复测量多元协方差分析评估了主要结果的组×时间交互作用。计算了随时间变化的韧性变化的效应大小。
在筛选的 456 名 IBD 患者中，有 394 名符合条件，其中 184 名 GP 和 210 名 NP。GP 的 HCU 减少幅度大于 NP：急诊就诊减少 71%，计划外住院减少 94%。GP 中阿片类药物使用减少 49%，皮质类固醇使用减少 73%。韧性增加了 27.3 分（59%），产生了较大的效应大小（d=2.4）。
在 IBD 护理背景下关注建立韧性的身心护理可能是减少计划外 HCU 和阿片类药物使用的一种新方法，但需要进行大型、多中心、随机对照试验。
