Access to Specialists and Emergency Department Visits in Inflammatory Bowel Disease: A Population-Based Study

医学 优势比 置信区间 急诊科 炎症性肠病 人口 逻辑回归 内科学 疾病 急诊医学 环境卫生 护理部
作者
Geoffrey C. Nguyen,Shelley Bouchard,Christina Diong
出处
期刊:Journal of Crohn's and Colitis [Oxford University Press]
卷期号:13 (3): 330-336 被引量:26
标识
DOI:10.1093/ecco-jcc/jjy161
摘要

The number of inflammatory bowel disease [IBD]-related visits to the emergency department [ED] is increasing in North America. This study evaluates the relationship between access to specialists and utilization of ED services.We conducted a population-based study of all IBD patients in Ontario in 2014-2015 to measure utilization of non-emergency IBD care by specialists [NICS] and ED visits. After characterizing regional variation in access to gastroenterologists and region-wide implementation of NICS, we constructed regression models to determine whether they were predictors of individual utilization of NICS and ED services.The number of gastroenterologists per 1000 IBD patients varied geographically, ranging from 1.13 to 10.65, as did the region-wide proportion of patients who received NICS, ranging from 21% to 52%. Compared with those with low access to gastroenterologists, those living in areas with moderate (odds ratio [OR], 2.37; 95% confidence interval [CI]: 2.27-2.47) and high [OR, 1.83; 95% CI: 1.71-1.95] access were more likely to receive NICS. The risk of visits to the ED was lower among those residing in regions with moderate [OR, 0.78; 95% CI: 0.75-0.82] and high access [OR, 0.74; 95% CI: 0.69-0.80] to gastroenterologists and in regions where implementation of NICS was not low [OR, 0.78; 95% CI: 0.75-0.81].Poor access to outpatient IBD specialist care contributes to IBD-related ED visits. Strategies to increase specialist access may reduce the utilization of emergency services.
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