Original Article
Alimentary Tract
Integrated Psychological Care Reduces Health Care Costs at a Hospital-Based Inflammatory Bowel Disease Service

https://doi.org/10.1016/j.cgh.2020.01.030Get rights and content

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.

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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    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.

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