title: Preventative care for patients with inflammatory bowel disease in the Veterans Health Administration.
abstract: Patients with inflammatory bowel disease (IBD) have underlying immune dysregulation. Immunosuppressive medications put them at risk of infection. This study assessed rates of recommended vaccinations and preventative screening in patients with IBD.Nationwide data on patients diagnosed with IBD in the Veterans Health Administration (VHA) October 2004 to September 2014 were extracted. Variation in vaccination, screenings, and risk of death by demographic factors (age group, gender) were estimated in bivariate and multivariable analyses.During the 10-year study period, 62,002 patients were treated for IBD. Nonmelanoma skin cancer was found in 2.6%, and these patients more commonly accessed dermatology clinic (22.5% vs 15.2%; chi-square = 66.6; df = 1; P < 0.0001). In total, 15% received DEXA scans, especially women (34.7% vs 13.2% men; chi-square = 1415.5; df = 1; P < 0.0001). Eye manifestations were noted in 38.3% yet only 31% were referred to ophthalmology. Abnormal Pap smears were found for 15% of women <65 (compared to 5% among normal patient populations); 34% had no record of Pap smear in VHA data. Vaccination rates were modest: pneumococcal 39%; TDAP 23%; hepatitis B 3%; varicella and PPD <0.5%. In an adjusted logistic regression model, 5-year mortality was lower among those using primary care prior to IBD diagnosis (odds ratio [OR] = 0.61; 95% CI 0.55-0.68).Despite the current IBD guidelines, vaccination and preventative screening rates were unacceptably low among patients diagnosed with IBD. Interventions such as education and increased awareness may be needed to improve these rates.
authors.affiliation: Gastroenterology Service, Central Texas Veterans Health Care System Division of Gastroenterology, Department of Medicine, Scott & White Memorial Hospital, Temple South Texas Veterans Health Care System, San Antonio Center for Applied Health Research, Central Texas Veterans Health Care System, Jointly With Scott & White Memorial Hospital Department of Medicine, Temple Department of Psychiatry, UT Health Science Center San Antonio, San Antonio, TX.
authors.forename: Nivedita
authors.initials: N
authors.lastname: Pandey
authors.forename: Henry H
authors.initials: HH
authors.lastname: Herrera
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Johnson
authors.forename: Andrea A
authors.initials: AA
authors.lastname: MacCarthy
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
mesh_terms: D000368:Aged; D015897:Comorbidity / Q000639:trends*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data*; D014728:Veterans