Though there are many overlapping features of clinical presentations among Inflammatory Bowel Disease (IBD) patients, there are key differences between Crohn's disease (CD) and Ulcerative Colitis (UC) that make CD more prone to severe symptomatology. CD can affect any part of the gastrointestinal tract, the full thickness of the bowel wall, and have skip lesions, whereas UC is limited to the colon, affects only the mucosa, and manifests as continuous colonic inflammation. CD patients have been observed to have a significantly decreased health-related quality of life compared to UC patients, and their quality of life is directly correlated with disease activity. Our study aim was to evaluate health care utilization between CD and UC patients.Methods:
Using electronic health records, we performed a retrospective review of IBD patients at an academic medical center over 6 months to evaluate the health care utilization between CD and UC patients. All IBD patients were under the care of faculty gastroenterologists. Data regarding demographics, IBD subtype, ER visits, physician office visits, phone calls, and email communications were compiled into a database while maintaining subject confidentiality. Statistical analysis was conducted using a 2-tailed Fisher's Exact Test with a significance set at P < 0.05.Results:
Out of 831 health care utilizations, 452 (54%) were from CD patients. CD patients had 35 (8%) ER visits, while UC patients had 11 (3%) ER visits (P = 0.0022). CD patients had 251 (56%) physician office visits, while UC patients had 178 (47%) physician office visits (P = 0.0148). UC patients had 134 (35%) email communications, while CD patients had 108 (24%) email communications (P = 0.0003). There were no statistically significant differences in phone calls between CD and UC patients.Conclusions:
Our data indicate that CD patients utilize significantly more in-person health services (i.e., ER visits and physician office visits) compared to UC patients. This finding supports the severe symptomatology experienced by CD patients as they likely seek more immediate medical attention than other IBD patients. We also observed that UC patients, however, utilize more email communication services. This further supports a less urgent need for medical attention among UC patients as they may experience less severe symptoms. It is also possible that UC patients have earlier recognition of their symptoms or a heightened awareness of their disease process. Our data are in-line with existing literature that has found CD to carry a greater economic burden in the US than UC. Our study emphasizes the need for improved anticipation of the health care needs of CD patients to ultimately reduce costs related to IBD treatment.