Morgan Kelli, Morris James, Cai Qiang, Kilgore Phillip, Cvek Urska, Trutschl Marjan, Lofton Katelynn T, Mavuram Meher Sindhoora, Ramesh Prerana, Dao Nhi, Alhaque Ahmed, Alexander Jonathan Steven
Department of Gastroenterology and Hepatology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA.
Department of Computer Science, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA.
Pathophysiology. 2024 Aug 12;31(3):398-407. doi: 10.3390/pathophysiology31030030.
Several studies have correlate improved patient outcomes with increased physician-patient contacts, particularly in chronic diseases. Extending this approach to inflammatory bowel disease (IBD) care presents a promising means of improving outcomes. At LSU Health Shreveport (LSUHS), a new approach called "STABILITY" (Symptomatic Review during Biologic Therapy) was implemented during infusion therapy visits for IBD patients. These brief 15 min physician-patient interviews aimed to discuss the patients' current IBD-related symptoms and evaluate the need for any changes in their treatment plan. Our goal was to remove a care gap and prevent intensifying symptoms created by missed appointments and loss of contact. To analyze the effectiveness of the STABILITY approach, a retrospective chart review was conducted on 111 IBD patients (18 with ulcerative colitis, 93 with Crohn's disease) seen at LSUHS between 2011 and 2022. Since March 2019, STABILITY has been mandatory for all infusion therapy visits. The data collected included patients' demographics, lab levels for biomarkers (fecal calprotectin, C-reactive protein, and erythrocyte sedimentation rates), hospitalizations, medication changes, and diagnosis dates before and after the implementation of STABILITY. Additionally, voluntary, anonymous infusion patient satisfaction surveys post-STABILITY were used to gather patient responses. In males with IBD, disease severity and hospitalizations were reduced significantly ( = 0.004 and 0.0234, respectively). In females with IBD, disease severity and hospitalizations were also reduced significantly ( = 0.0001 and 0.0072, respectively). In patients with UC and CD, there were significant improvements in disease severity ( = 0.043 and = 0.0001, respectively), and CD hospitalizations were also improved ( = 0.0013). In males and females with UC, disease severity was marginally and significantly reduced ( = 0.0781 and = 0.0379, respectively). In males and females with CD, disease severity was significantly reduced ( = 0.0161 and 0.0003, respectively), and CD male and female hospitalizations were also reduced significantly ( = 0.0436 and 0.013). Analyzing of survey responses, we found that the most patients reported improved IBD symptoms (56%), gained understanding of their condition (84%) and were in favor of continuing STABILITY consultations during infusion therapy (93%). To further investigate the impact of STABILITY, we conducted a comparative analysis between IBD patients undergoing STABILITY infusion therapy and LSUHS patients solely on self-injectable biologics. Our paired data analysis showed significant improvements in disease severity in female IBD patients (1.69 ± 0.13 vs. 1.41 ± 0.12, = 0.0001) and male IBD patients (1.58 ± 0.16 vs. 1.2 ± 0.135, = 0.004), in UC patients (1.833 ± 0.4.2 vs. 1.444, = 0.043), in all CD patients (1.59 ± 0.11 vs. 1.29 ± 0.01, = 0.0001), in male CD patients (1.52 ± 0.167 vs. 1.15 ± 0.15, = 0.016), in female CD patients (1.66 ± 0.15 vs. 1.4 ± 0.13, = 0.0003), in female UC patients (1.82 ± 0.32 vs. 1.45 ± 0.31, = 0.0379), and marginally in male UC patients ( = 0.0781). Similarly, hospitalizations were significantly reduced in CD patients considered in aggregate (0.21 ± 0.04 vs. 0.11 ± 0.03, = 0.0013), in male IBD patients (0.175 ± 0.06 vs. 0.05 ± 0.035, = 0.024), in female IBD patients (0.21 ± 0.05 vs. 0.11 ± 0.04, = 0.0072), in male CD patients (0.18 ± 0.07 vs. 0.06 ± 0.042, = 0.0436), and in females with CD (0.23 ± 0.06 vs. 0.13 ± 0.04, = 0.013). Although average values for fecal calprotectin, CRP, and sedimentation rate were frequently reduced after STABILITY interviews, these data did not reach statistical significance. These preliminary findings suggest that STABILITY may be effective in maintaining low disease activity or remission in IBD patients.
多项研究表明，增加医患接触次数可改善患者预后，尤其是在慢性病治疗中。将这种方法应用于炎症性肠病（IBD）护理，有望改善治疗效果。在路易斯安那州立大学什里夫波特健康科学中心（LSUHS），一种名为“STABILITY”（生物治疗期间的症状复查）的新方法在IBD患者的输液治疗期间实施。这些时长15分钟的简短医患面谈旨在讨论患者当前与IBD相关的症状，并评估其治疗计划是否需要调整。我们的目标是消除护理缺口，防止因错过预约和失去联系而导致症状加重。为了分析STABILITY方法的有效性，我们对2011年至2022年期间在LSUHS就诊的111例IBD患者（18例溃疡性结肠炎患者，93例克罗恩病患者）进行了回顾性病历审查。自2019年3月起，STABILITY对所有输液治疗就诊均为强制性要求。收集的数据包括患者的人口统计学信息、生物标志物的实验室水平（粪便钙卫蛋白、C反应蛋白和红细胞沉降率）、住院情况、用药变化以及STABILITY实施前后的诊断日期。此外，还使用了STABILITY实施后自愿、匿名的输液患者满意度调查来收集患者的反馈。在患有IBD的男性中，疾病严重程度和住院次数显著降低（分别为P = 0.004和0.0234）。在患有IBD的女性中，疾病严重程度和住院次数也显著降低（分别为P = 0.0001和0.0072）。在溃疡性结肠炎（UC）和克罗恩病（CD）患者中，疾病严重程度有显著改善（分别为P = 0.043和P = 0.0001），CD患者的住院情况也有所改善（P = 0.0013）。在患有UC的男性和女性中，疾病严重程度略有降低且具有统计学意义（分别为P = 0.0781和P = 0.0379）。在患有CD的男性和女性中，疾病严重程度显著降低（分别为P = 0.0161和0.0003），CD男性和女性的住院次数也显著降低（分别为P = 0.0436和0.013）。通过对调查反馈的分析，我们发现大多数患者报告IBD症状有所改善（56%），对自身病情有了更深入的了解（84%），并赞成在输液治疗期间继续进行STABILITY咨询（93%）。为了进一步研究STABILITY的影响，我们对接受STABILITY输液治疗的IBD患者与仅使用自我注射生物制剂的LSUHS患者进行了对比分析。我们的配对数据分析显示，女性IBD患者（1.69±0.13 vs. 1.41±0.12，P = 0.0001）、男性IBD患者（1.58±0.16 vs. 1.2±0.135，P = 0.004）、UC患者（1.833±0.42 vs. 1.444，P = 0.043）、所有CD患者（1.59±0.11 vs. 1.29±0.01，P = 0.0001）、男性CD患者（1.52±0.167 vs. 1.15±0.15，P = 0.016）、女性CD患者（1.66±0.15 vs. 1.4±0.13，P = 0.0003）、女性UC患者（1.82±0.32 vs. 1.45±0.31，P = 0.0379）以及男性UC患者（P = 0.0781）的疾病严重程度均有显著改善。同样，总体上CD患者的住院次数显著减少（0.21±0.04 vs. 0.11±0.03，P = 0.0013），男性IBD患者（0.175±0.06 vs. 0.05±0.035，P = 0.024）、女性IBD患者（0.21±0.05 vs. 0.11±0.04，P = 0.0072）、男性CD患者（0.18±0.07 vs. 0.06±0.042，P = 0.0436）以及女性CD患者（0.23±0.06 vs. 0.13±0.04，P = 0.013）的住院次数也显著减少。尽管在STABILITY面谈后，粪便钙卫蛋白、CRP和沉降率的平均值经常降低，但这些数据未达到统计学意义。这些初步研究结果表明，STABILITY可能有助于维持IBD患者的低疾病活动度或缓解状态。
