title: An integrated model of care for inflammatory bowel disease sufferers in Australia: development and the effects of its implementation.
abstract: BACKGROUND
  Psychological comorbidities are associated with poor outcome and increased healthcare utilization in patients with inflammatory bowel disease (IBD). However, a model of care addressing the biopsychosocial dimension of disease is not routinely applied in IBD. This review describes the development of such a model and the effects of its implementation in a hospital-based cohort of patients with IBD.
  
  
  METHODS
  Three different approaches were used: 1) collecting baseline epidemiological data on mental health comorbidities; 2) raising awareness of and targeting mental health problems; 3) examining the effects of the model implementation.
  
  
  RESULTS
  High rates of anxiety and depressive symptoms (36% and 13%, respectively) that are maintained over time were identified in IBD patients presenting at a metropolitan teaching hospital. Patients with documented psychological comorbidities were more likely to be hospitalized than those without (odds ratio [OR] = 4.13, 95% confidence interval [CI]: 1.25, 13.61). Improvements in disease activity, anxiety, depression, quality of life, and coping have been noted when cognitive-behavioral therapy (CBT) was provided to patients. A drop in the use of opiates (P = 0.037) and hospitalization rates (from 48% to 30%) in IBD patients has been noted as a result of introduction of the changed model of care. In addition, the mean total cost of inpatient care was lower for IBD patients than controls (US$12,857.48 [US$15,236.79] vs. US$ 30,467.78 [US$ 53,760.20], P = 0.005).
  
  
  CONCLUSIONS
  Our data to date suggest that an integrated model of care for patients with IBD may yield superior long-term outcomes in terms of medication use and hospitalization rates and reduce healthcare costs.
authors.affiliation: School of Nursing and Midwifery and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia. antonina.mikocka-walus@unisa.edu.au
authors.forename: Antonina A
authors.initials: AA
authors.lastname: Mikocka-Walus
authors.forename: Deborah
authors.initials: D
authors.lastname: Turnbull
authors.forename: Gerald
authors.initials: G
authors.lastname: Holtmann
authors.forename: Jane M
authors.initials: JM
authors.lastname: Andrews
mesh_terms: D001315:Australia; D019033:Delivery of Health Care, Integrated; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics / Q000523:psychology / Q000628:therapy*; D013315:Stress, Psychological / Q000523:psychology*