title: Acceptance of inflammatory bowel disease treatment recommendations based on appropriateness ratings: do practicing gastroenterologists agree with experts?
abstract: BACKGROUND
  Appropriateness criteria for the treatment of Crohn’s disease (CD) and ulcerative colitis (UC) have been developed by expert panels. Little is known about the acceptance of such recommendations by care providers. The aim was to explore how treatment decisions of practicing gastroenterologists differ from those of experts, using a vignette case study and a focus group.
  
  
  METHODS
  Seventeen clinical vignettes were drawn from clinical indications evaluated by the expert panel. A vignette case questionnaire asking for treatment options in 9 or 10 clinical situations was submitted to 26 practicing gastroenterologists. For each vignette case, practitioners’ answers on treatments deemed appropriate were compared with panel decisions. Qualitative analysis was performed on focus group discussion to explore acceptance and divergence reasons.
  
  
  RESULTS
  Two hundred thirty-nine clinical vignettes were completed, 98 for CD and 141 for UC.Divergence between proposed treatments and panel recommendations was more frequent for CD (34%) than for UC (27%). Among UC clinical vignettes, the main divergences with the panel were linked to 5-aminosalicylate (5-ASA) failure assessment and to situations in which stopping treatment was the main decision. For CD, the propositions of care providers diverged from the panel in mild to moderate active disease, for which practitioners were more prone to an accelerated step-up than the panel’s recommendations.
  
  
  CONCLUSIONS
  In about one-third of vignette cases, inflammatory bowel disease treatment propositions made by practicing gastroenterologists diverged from expert recommendations. Practicing gastroenterologists may experience difficulty in applying recommendations in daily practice.
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
authors.forename: Michel H
authors.initials: MH
authors.lastname: Maillard
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Lauvergeon
authors.forename: Marjan
authors.initials: M
authors.lastname: Timmer
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
authors.forename: Florian
authors.initials: F
authors.lastname: Froehlich
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Vader
authors.forename: Christian
authors.initials: C
authors.lastname: Mottet
mesh_terms: D019468:Disease Management; D005762:Gastroenterology / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D011795:Surveys and Questionnaires; D013557:Switzerland