A national survey on the patterns of treatment of inflammatory bowel disease in Canada.
BACKGROUND
There is a general lack of information on the care of inflammatory bowel disease (IBD) in a broad, geographically diverse, non-clinic population. The purposes of this study were (1) to compare a sample drawn from the membership of a national Crohn's and Colitis Foundation to published clinic-based and population-based IBD samples, (2) to describe current patterns of health care use, and (3) to determine if unexpected variations exist in how and by whom IBD is treated.


METHODS
Mailed survey of 4453 members of the Crohn's and Colitis Foundation of Canada. The questionnaire, in members stated language of preference, included items on demographic and disease characteristics, general health behaviors and current and past IBD treatment. Each member received an initial and one reminder mailing.


RESULTS
Questionnaires were returned by 1787, 913, and 128 people with Crohn's disease, ulcerative colitis and indeterminate colitis, respectively. At least one operation had been performed on 1159 Crohn's disease patients, with risk increasing with duration of disease. Regional variation in surgical rates in ulcerative colitis patients was identified. 6-mercaptopurine/azathioprine was used by 24% of patients with Crohn's disease and 12% of patients with ulcerative colitis (95% CI for the difference: 8.9%-15%). In patients with Crohn's disease, use was not associated with gender, income or region of residence but was associated with age and markers of disease activity. Infliximab was used by 112 respondents (4%), the majority of whom had Crohn's disease. Variations in infliximab use based on region of residence and income were not seen. Sixty-eight percent of respondents indicated that they depended most on a gastroenterologist for their IBD care. There was significant regional variation in this. However, satisfaction with primary physician did not depend on physician type (for example, gastroenterologist versus general practitioner).


CONCLUSIONS
This study achieved the goal of obtaining a large, geographically diverse sample that is more representative of the general IBD population than a clinic sample would have been. We could find no evidence of significant regional variation in medical treatments due to gender, region of residence or income level. Differences were noted between different age groups, which deserves further attention.
Hilsden
Robert J
RJ
Department of Medicine, University of Calgary, Calgary, AB, Canada. rhilsden@ucalgary.ca
Verhoef
Marja J
MJ
Best
Allan
A
Pocobelli
Gaia
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage; D002170:Canada / Q000453:epidemiology*; D003092:Colitis / Q000453:epidemiology / Q000628:therapy; D003093:Colitis, Ulcerative / Q000453:epidemiology / Q000628:therapy; D003424:Crohn Disease / Q000453:epidemiology / Q000628:therapy; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000628:therapy*; D000069285:Infliximab; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011159:Population Surveillance
D000911:Antibodies, Monoclonal; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine