title: Clinicians' adherence to international guidelines in the clinical care of adults with inflammatory bowel disease.
abstract: BACKGROUND
  Although evidence-based guidelines have been developed for inflammatory bowel disease (IBD), the extent to which they are followed is unclear. The objective of this study was to review clinicians' adherence to international IBD guidelines.
  
  
  METHODS
  Retrospective data collection of patients attending a tertiary Australian hospital IBD clinic over a 12-month period. Management practices were audited and compared to ECCO (European Crohn's and Colitis Organization) guidelines.
  
  
  RESULTS
  Data from 288 patients were collected: 47% (136/288) male; mean age 43; 140/288 (49%) patients had ulcerative colitis (UC); 145/288 (50%) patients had Crohn's disease (CD); 3/288 (1%) patients had IBD-unclassified (IBD-U). Patient care was undertaken by gastroenterologists, trainees and general practitioners.
  
  
  METHODS
  Overall adherence to disease management guidelines occurred in 204/288 (71%) of patient encounters. Discrepancies between guidelines and management were found in: 25/80 (31%) of patients with UC in remission receiving oral 5-aminosalicyclates (5-ASAs) as maintenance therapy, and; 46/110 (42%) of patients with small bowel and/or ileo-cecal CD receiving 5-ASA. Preventive Care: Adherence to ≥1 additional component of preventive care was observed in 73/288 (25%) of patient encounters: 12/133 (9%) on thiopurines underwent annual skin checks; 61/288 (21%) of patients with IBD underwent a bone scan; 46/288 (16%) patients were reminded to have their influenza vaccine. Psychological care: Assessment of psychological wellbeing was undertaken in only 16/288 (6%) of patients.
  
  
  CONCLUSIONS
  There remains a gap between adherence to international guidelines and clinical practice. Standardizing practice using evidence-based clinical pathways may be a strategy towards improving the quality of IBD outpatient management.
authors.affiliation: a Department of Gastroenterology , The Austin Hospital , Melbourne , Australia.|b University of Melbourne, Department of Medicine , Austin Academic Centre , Melbourne , Australia.
authors.forename: Belinda D
authors.initials: BD
authors.lastname: Jackson
authors.affiliation: a Department of Gastroenterology , The Austin Hospital , Melbourne , Australia.|b University of Melbourne, Department of Medicine , Austin Academic Centre , Melbourne , Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Con
authors.affiliation: c School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.affiliation: a Department of Gastroenterology , The Austin Hospital , Melbourne , Australia.|b University of Melbourne, Department of Medicine , Austin Academic Centre , Melbourne , Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: De Cruz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001315:Australia; D003113:Colonoscopy; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011613:Psychotherapy; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine
keywords: Inflammatory bowel disease; guidelines; quality of care