title: Gastroenterologists' attitudes and self-reported practices regarding inflammatory bowel disease.
abstract: BACKGROUND
  The purpose was to assess organization-, physician-, and patient-based aspects of inflammatory bowel disease (IBD) practice variation within an integrated care delivery system and the extent to which physicians are interested in adopting a chronic care model and/or nurse assistance to manage IBD patients.
  
  
  METHODS
  As part of an observational cohort study to understand variation in IBD care and outcomes, we conducted semistructured, open-ended interviews with 17 gastroenterologists and 1 gastroenterology registered nurse at 6 clinics in an integrated care delivery system. Interviews were taperecorded and transcribed. We coded and analyzed transcripts using standard qualitative methods.
  
  
  RESULTS
  Physicians reported a range of attitudes and practices regarding IBD. Analysis showed differences in 3 domains and 8 subdomains: 1) patient education and choices, including health education and patient use of complementary and alternative medicine; 2) decisions about diagnosis and treatment, including practice guidelines, conferring with colleagues, using infliximab, and medical hospitalization; and 3) organizational aspects of care, including primary care involvement with IBD and MD attitudes toward ancillary support.
  
  
  CONCLUSIONS
  Standardized algorithms on care for IBD patients do not exist, but opportunities may exist to improve IBD care by: having initial work-ups and management of patients in remission in primary care; creating and maintaining opportunities for gastroenterologists to confer with colleagues and acknowledged local experts; and having nurse coordination for medications and labs and/or some type of specialty IBD clinic for high-need patients. This research highlights the need for more directed comparative efficacy and effectiveness trials that will serve to define preferred treatment strategies.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California 94612, USA. Andrea.Altschuler@kp.org
authors.forename: Andrea
authors.initials: A
authors.lastname: Altschuler
authors.forename: Bernadette
authors.initials: B
authors.lastname: Collins
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
authors.forename: Fernando
authors.initials: F
authors.lastname: Velayos
authors.forename: James E
authors.initials: JE
authors.lastname: Allison
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Liyan
authors.initials: L
authors.lastname: Liu
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
mesh_terms: D001291:Attitude of Health Personnel; D015331:Cohort Studies; D000529:Complementary Therapies; D003657:Decision Making; D005762:Gastroenterology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy; D007407:Interviews as Topic; D009726:Nurses; D005791:Patient Care / Q000379:methods; D010353:Patient Education as Topic