Background: In patients with Inflammatory Bowel Disease (IBD), anxiety and depression are known to be risk factors for increased hospitalisation and poor self-management practices such as low medication adherence and continued smoking. It is not yet known whether integrating psychological care in the outpatient IBD setting has a potential to yield economic or healthcare utilisation benefits. As part of a broader study investigating the need for and usefulness of integrated psychological support in IBD care (see abstract A-1765), we report here on initial data on the mental health and healthcare utilisation of patients in an established IBD service.
Methods: Potential participants were drawn from the IBD service at a large tertiary hospital, and were recruited via post and in-person at scheduled outpatient appointments. Screening data were gathered by questionnaire: mental health with the Hospital Anxiety and Depression Scale (HADS) and the Kessler 6 Scale (K6), medication adherence with the Morisky Medication Adherence Scale (MMAS-8) and quality of life by the Assessment of Quality of Life measure (AQoL-8D). Demographic and healthcare utilisation data for the twelve months prior to psychological screening were collected by electronic state-wide hospital records.
Results: 500 patients were approached; 67% participated in psychological screening and 37% scored within clinical ranges. An index of total healthcare utilisation was computed (comprising presentations to emergency, ward admissions, endoscopic and radiologic procedures, outpatient appointments and cancellations/no-shows). This index was significantly related to depression (r=0.131, p=0.018) and general distress (r=0.124, p=0.026). A further breakdown revealed small, positive correlations between general distress and emergency presentations (r=0.154, p=0.005), outpatient appointments (r=0.118, p=0.033), and appointment cancellations (r=0.168, p=0.002). There was also a small, positive correlation between depression and appointment cancellations (r=0.110, p=0.045). While anxiety was not related to the total healthcare utilisation index, there were small, positive correlations between anxiety and emergency presentations (r=0.124, p=0.024), outpatient appointments (r=0.119, p=0.030), and appointment cancellations (r=0.155, p=0.005).
Conclusions: Psychological distress was associated with increased healthcare utilisation in patients with IBD, in particular with emergency presentations, outpatient appointments and cancellation/no-show at scheduled appointments. These results provide support for psychological care being integrated into current IBD practice (where modifiable factors could be addressed more efficiently). Further data being gathered at present will determine any potential economic benefits of this approach.