摘要
Background and aims:With expanding available treatment options and evolving understanding of the risks and benefits of medical therapies for inflammatory bowel disease(IBD),there is the possibility of significant variations in treatment and outcomes.Little is known about the variation in treatment between IBD specialists and other gastroenterology(GI)physicians.Evaluating possible variations is an important first step to help address standardized care and optimize treatment.We studied the differences in use of biologics and immunomodulators in the management of IBD patients at a tertiary care hospital between IBD-trained physicians and other gastroenterologists.Methods:A total of 325 IBD patients were included in the analysis.Of these,216 patients received care with an IBD physician and 109 had other GI/non-IBD physicians as their main caregivers.Results:The unadjusted use of immunomodulators(35.6%vs 16.5%,p¼0.001),biologics(45.8%vs 22.9%,p¼0.001)and dual therapy(biologics and immunomodulator)(14.4%vs 3.7%,p¼0.001)was significantly higher in the IBD-physician group.These differences in therapy between the two groups remained after adjusting for patient and disease characteristics.Conclusion:There are significant variations in the treatment of patients with IBD by GI physicians.The use of biologics and immunomodulators is higher in GI physicians with dedicated IBD interest and training.
背景与目的:随着炎症性肠病(IBD)治疗药物选择的不断增多以及对药物治疗风险和获益认识的不断深入,IBD患者的治疗方式和临床结局可能存在显著的差异。对于IBD专科医生与其他胃肠科医生之间的治疗差异,目前所知甚少。评估这种可能的差异是开展规范化治疗和优化治疗方式的重要前提。我们分析了一家三甲医院IBD专科医生与其他胃肠科医生进行IBD生物治疗和免疫治疗中存在的差异。方法:共计325名IBD患者纳入研究,其中216例接受IBD专科医生的治疗,另外109例由非IBD专科的胃肠科医生担任他们的主治医生。结果:由IBD专科医生施治的患者,其接受免疫抑制剂(35.6%vs 16.5%,P=0.001)、生物制剂(45.8%vs 22.9%,P=0.001)和双药联合治疗(14.4%vs 3.7%,P=0.001)的比例明显高于在其他胃肠科医生就治的患者。在对患者及疾病特征进行调整后,这些差异仍然存在。结论:不同的胃肠科医生对于IBD患者的治疗策略存在显著差异,其中IBD专科医生更倾向于采用生物治疗和免疫治疗。
