Original ArticleAlimentary TractIntegrated Psychological Care Reduces Health Care Costs at a Hospital-Based Inflammatory Bowel Disease Service
Section snippets
Participants and Procedures
Full details of the study methods are outlined in our previous paper (see Lores et al14). Individuals were recruited from an established adult IBD service in a large Australian metropolitan teaching hospital between September 2015 and August 2016 (screening year). Consecutive patients with IBD were identified from weekly clinic lists, sent study information and screening questionnaires, and then approached in person at their appointment. Participation in screening was voluntary; declining
Health Care Use in the 12 Months Before Screening
A description of participant characteristics is provided in our previous paper.14 Screening participants (n = 335) had a greater number of IBD nurse helpline contacts than those who declined screening (n = 155; Supplementary Table 1). There were no other significant differences in health care use between individuals who participated in psychological screening and those who did not (data not shown, all P > .05).
Discussion
Consistent with previous research,5 our evaluation of integrated psychological care for patients with IBD found that MHIs are associated with greater costs and use of health care services. Patients who screened positive for being at risk for MHIs were 1.8 times more likely to present to a hospital ED. Additionally, higher levels of depression and general distress were related to greater odds of hospital admission and a higher number of attended and nonattended outpatient appointments. These
Acknowledgments
The authors acknowledge the nurses and doctors in the IBD Service at the Royal Adelaide Hospital for their support in seamlessly integrating psychology into the service. Support from Kylie Lange from the University of Adelaide statistical support service was greatly appreciated. The authors also thank the patients of the IBD service for their openness, participation, and feedback. Use of the Morisky Medication Adherence Scale is protected by US copyright laws. Permission for use is required. A
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2022, Clinical Gastroenterology and HepatologyCitation Excerpt :For example, the UPMC Total Care Program was offered within a single-payor model and focused on providing psychiatric consultation and behavioral support to patients with a documented comorbid psychiatric condition and high utilization.27 In an Australian IBD Center, outcomes were improved when the subset of IBD patients screening positive for depression or anxiety were identified and provided mental health support services within the IBD center.28 It is possible that our patients, who were less psychologically disabled at the time they were offered integrated care, were better able to implement and adhere to recommended medical, behavioral, lifestyle, and dietary changes.
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2022, The Lancet Gastroenterology and HepatologyCitation Excerpt :Integration of such mental health screening in patients with IBD could have significant benefits, particularly in reducing health-care utilisation. A randomised controlled trial of a mental health screening, followed by referral to a mental health professional as needed, was associated with lower health-care costs than the standard of care.48 In addition to mood, high degree of perceived stress can be a trigger of symptoms,49,50 although such symptoms might not always reflect active inflammatory disease.51–53
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2022, GastroenterologyCitation Excerpt :Several United States, Canadian, United Kingdom, and Australian academic gastroenterology divisions also employ full-time gastropsychologists who provide individual and group psychotherapy services to patients, but not necessarily in the context of a subspecialty medical home as in TotalCare or GRITT-IBD. For example, an Australian-based IBD integrated care model showed similar reductions in unplanned care when patients who were screened for mental health comorbidities were treated by the center’s gastropsychologist or referred to a psychologist in the community,19,44 and a United States-based program demonstrated improvement in quality of life among patients with IBS and IBD with brain-gut dysregulation, somatization, or depression.47 In a partially integrated model, common in the United States and Canada, a single gastropsychologist (or in the United States, medical social worker) offers specialized but restricted services.
Conflicts of interest These authors disclose the following: Antonina Mikocka-Walus declares speaker’s fees for Janssen and Ferring. Anne L. J. Burke declares speaker’s fees for Indivior, Sequiris, and Mundipharama. Jane M. Andrews declares speaker’s fees, research support, and/or Ad Boards for Abbott, AbbVie, Allergan, AstraZeneca, Bayer, Celegene, Ferring, Gilead, Hospira, ImmunsanT, Janssen, MSD, Nestle, Novartis, Pfizer, Shire, Takeda, and Vifor. The remaining authors disclose no conflicts.
Funding This work was supported by a peer-reviewed grant from the Gastroenterological Society of Australia funded by Janssen (Inflammatory Bowel Disease Centre of Excellence Award), and funds raised by the Royal Adelaide Hospital Research Fund administered by the Health Services Charitable Gifts Board.