title: Managing chronic disease in Ireland: hospital admission rates and clinical outcomes in a large ulcerative colitis population.
abstract: BACKGROUND
  Health care planning demands a detailed knowledge of the course of chronic diseases in the Irish population. This study describes hospital admission rates, medication use and outcomes in a large cohort of patients with ulcerative colitis attending a tertiary referral centre in Ireland.
  
  
  METHODS
  Four hundred and twenty-four patients who attended during the 18-year period from January 1991 to January 2009 were identified. Baseline demographics, hospital admission, medications required, extent of colitis and date of colectomy were recorded.
  
  
  RESULTS
  More than half (55.4%) of the patients were managed exclusively in an outpatient setting throughout diagnosis and follow-up. Systemic corticosteroids, thiopurines and infliximab were required by 70, 29.5 and 5% of the patients, respectively. Overall 5-year colectomy rate due to failure of medical therapy was 15.8%. Independent predictors of colectomy were hospital admission at first presentation (odds ratio 3.6, p < 0.0001) and pancolitis at diagnosis (odds ratio 2.3, p < 0.01).
  
  
  CONCLUSIONS
  The majority of patients with colitis have an uncomplicated disease course and do not require thiopurines, biologic agents or hospital admission. Principal management at a primary care level may be appropriate in many cases. Colectomy rates at a specialist centre in Ireland compare favourably with international figures.
authors.affiliation: Department of Medicine, Alimentary Pharmabiotic Centre, Cork University Hospital, University College Cork, National University of Ireland, Wilton, Cork, Ireland. AlanNDesmond@gmail.com
authors.forename: A N
authors.initials: AN
authors.lastname: Desmond
authors.forename: F
authors.initials: F
authors.lastname: Shanahan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D000069285:Infliximab; D007494:Ireland; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011239:Prednisolone; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine; D006854:Hydrocortisone