Background & Aims

Inflammatory bowel diseases (IBD) are associated with high psychosocial burden and economic cost. Integrating psychological care into routine management might lead to savings. We performed a 2-year investigation of the effects of integrated psychological care in reducing healthcare use and costs.

Methods

We performed a prospective study of 335 adult patients treated at a hospital-based IBD service in Australia. Participants were recruited between September 2015 and August 2016 and completed screening instruments to evaluate mental health and quality of life. Data on healthcare use and costs for the previous 12 months were also collected. Patients found to be at risk for mental health issues were offered psychological intervention. Patients were followed up 12 months after screening (between September 2016 and August 2017).

Results

A significantly higher proportion of subjects at risk for mental health issues had presented to an emergency department in the 12 months before screening (51/182; 28%) compared to psychologically healthy subjects (28/152; 18%; X²(1) = 4.23; P = .040). Higher levels of depression and general distress (but not anxiety) were related to increased odds of hospital admission (adjusted odds ratios, 1.07 and 1.05, respectively). Among the patients who accepted psychological intervention, the number who presented to emergency departments was reduced significantly in the 12 months after screening (follow-up) compared to the 12 months before screening (P = .047), resulting in a cost saving of AU$30,140 ($20,816 USD). A cost-benefit analysis of the integrated psychological care model revealed a net saving of AU$84,905 ($58,647 USD) over a 2-year period.

Conclusions

Risk for mental health issues is associated with higher healthcare costs in people with IBD. Providing integrated psychological care to individuals at risk for mental health issues can reduce costs, particularly by decreasing visits to emergency departments. Further studies are required to determine the best care to provide to reduce costs.

中文翻译：

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综合心理护理降低了基于医院的炎症性肠病服务的医疗保健成本。

背景与目标

炎症性肠病 (IBD) 与高心理社会负担和经济成本有关。将心理护理融入日常管理可能会节省开支。我们对综合心理护理在减少医疗保健使用和成本方面的影响进行了为期 2 年的调查。

方法

我们对在澳大利亚一家基于医院的 IBD 服务处接受治疗的 335 名成年患者进行了一项前瞻性研究。参与者是在 2015 年 9 月至 2016 年 8 月期间招募的，并完成了评估心理健康和生活质量的筛查工具。还收集了过去 12 个月的医疗保健使用和成本数据。发现有心理健康问题风险的患者接受了心理干预。筛选后 12 个月（2016 年 9 月至 2017 年 8 月）对患者进行了随访。

结果

与心理健康受试者 (28/152; 18%; X ² (1) = 4.23；P = .040）。较高水平的抑郁和一般痛苦（但不是焦虑）与住院几率增加有关（调整后的几率分别为 1.07 和 1.05）。在接受心理干预的患者中，与筛查前12个月相比，筛查后12个月（随访）到急诊科就诊的人数明显减少（P = .047），从而节省了 30,140 澳元（20,816 美元）的成本。综合心理护理模型的成本效益分析显示，2 年期间净节省 84,905 澳元（58,647 美元）。

结论

精神健康问题的风险与 IBD 患者较高的医疗保健费用有关。为有心理健康问题风险的个人提供综合心理护理可以降低成本，特别是通过减少对急诊室的访问。需要进一步研究以确定提供的最佳护理以降低成本。