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Journal of Crohn's and Colitis: 11 (1)


Laurence J. Egan, Ireland

Associate Editors

Shomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKJesús Rivera-Nieves, USABritta Siegmund, GermanyGijs van den Brink, NLSéverine Vermeire, Belgium


Published on behalf of

An improved model of care for inflammatory bowel disease (IBD)

Antonina Mikocka-Walus, Jane M. Andrews, Roland von Känel, Gabriele Moser
DOI: http://dx.doi.org/10.1016/j.crohns.2012.08.004 e120-e121 First published online: 1 April 2013

Dear Sir,

Recommendations from the 3rd round of the Report of the results for the national clinical audit of adult inflammatory bowel disease (IBD) inpatient care in the UK published earlier this year by UK's Royal College of Physicians and mentioned in the Lancet in March 20121 report improvements in the quality of care (QoC) of patients with IBD since audits began in 2006 but also list improvements yet to be achieved. Importantly, optimising the quality of life (QoL) of sufferers was indicated as deserving greater attention as part of the global approach to improved QoC.

Our research to date2 and observations of several IBD centres worldwide3 have led us to believe that better QoC and thus QoL can more effectively be achieved through the use of an integrated model of care as opposed to a more simplistic biomedical approach to IBD care which persists in many sites where IBD care is delivered worldwide.

The integrated model of care approaches IBD from a holistic perspective acknowledging both physiological and psychosocial dimensions of the disease, and offering a collaborative, team-based approach with improved patient–doctor communication. Current IBD care is likely to remain suboptimal if it doesn't recognise and address QoL – independent from disease activity – as an important discrete health domain in IBD, particularly since the IBD disease course appears to be inter-related to mental health.4

The integrated model of care, apart from addressing the psychological needs of patients and improving their QoL together with addressing somatic symptoms may also offer substantial reductions in inpatient healthcare costs.5 These result from less frequent visits to the clinic, fewer hospital admissions, and less polypharmacy (especially steroids and opiates) since the disease flares are detected earlier and pro-actively managed. As an unexpected by-product of this, doctors may gain more time for patients needing attention as fewer patients report with emergencies and as a result the average time available per presenting patient can rise potentially improving the QoC further.

However, the model – despite its clear advantages – is not available to the average IBD patient, with only selected clinics offering it to their patients. The model should be promoted on the policy level rather than by waiting for individual practitioners to re-invent the wheel centre-by-centre, providing equal access to better quality care for IBD suffers on a larger scale than is currently achieved.

Conflict of interest

No conflict of interest was identified.


The first author would like to acknowledge the Brocher Foundation for awarding her a monthly residency fellowship in Geneva enabling a collaborative work on this paper.


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