IBD Management: Where Are the Knowledge Gaps?

LAS VEGAS — Drug holidays, monotherapy versus combination therapy, and treating seniors were areas that healthcare professionals said they were not entirely comfortable with in inflammatory bowel disease (IBD) management, according to a survey study.

Among 197 respondents, the following were highlighted as areas needing more education: making therapy choices related to drug holidays (25%), biosimilars (24%), and JAK inhibitors (28%); prescribing legalized medical marijuana for pain (62%); caring for patients with a history of malignancy (35%); and treating the elderly (30%) and pregnant women or those planning for a family (34%), reported Lisa Malter, MD, of New York University School of Medicine in Manhattan.

The role of advanced practice clinicians, treatment options, and management strategies for IBD have changed, and the Crohn’s and Colitis Foundation has attempted to better understand the resource needs and education gaps affecting clinicians who treat IBD, Malter stated here at the Crohn’s & Colitis Congress.

As IBD management techniques and therapies have advanced, more focus is placed on high-quality, multidisciplinary care, including gastroenterologists, but also advanced practice providers and nurses. Shared decision-making has also been given more consideration, she said.

“Education on therapeutics including JAK-inhibitors, biosimilars, and managing drug holidays is warranted. Education regarding the management of special populations including the elderly, those that are pregnant and those with prior malignancy should be prioritized. There’s an overarching need for pain management skills in IBD professionals, including the use of medical cannabis,” Malter said.

The foundation’s Professional Needs Assessment Task Force designed a 19-question online survey that collected information on comfort level concerning diagnosis, therapy, and monitoring of IBD patients, as well as demographics, prevention, and use of resources.

The questionnaire was distributed to Crohn’s & Colitis Foundation professional members as an embedded link as well as through social media to collect information from a diverse group of respondents. Professionals were not eligible for the study if they did not actively see IBD patients in clinical practice.

Chi-squared tests were used to identify differences in practitioners’ comfort levels with meeting and assessing patient needs, prescribing therapies, and shared decision-making based on patient care type, duration of practice, kind of practice setting, and degree type.

Of the respondents, 25% were advanced practice nurses (APNs) or registered nurses (RNs) — with a variety of degrees (PA, BSN, MSN, PhD) — while 75% were MDs.

They treated pediatric patients (24%), adult patients (70%), or both (6%). For practice environments represented, 16% were in hybrid, community, or university affiliated hospitals, 57% were in university or academic practice, and 27% were in private practice.

As far as volume of IBD, for more than one-third of practitioners, IBD patients accounted for >60% of their practice. Social work practice resources were available for 35% of adult practices and 72% of pediatric practices. Mental health specialists were available in 37% of adult practices and 52% of pediatric practices.

When compared with APNs/RNs, MDs were more comfortable recommending perianal CD therapy (63% vs 83%), diagnostic testing or making an IBD diagnosis (79% vs 96%), and severity and phenotype (71% vs 91%).

When compared with pediatric providers, adult providers were more comfortable suggesting post-operative IBD care (48% vs 84%).

When compared with RNs/APNs, MDs were more comfortable suggesting surgery as the optimal treatment (64% vs 85%) and monotherapy versus combination therapy (71% vs 88%). When compared with pediatric providers, adult providers were more comfortable suggesting drug holiday (21% vs 67%), IL-12/23 inhibitors (46% vs 76%), biosimilars (36% vs 61%), and JAK-inhibitors (14% vs 59%).

For shared decision-making, the respondents cited the following barriers:

• Training: 13%
• Language barriers: 2%
• Patient health literacy: 31%
• Time 43%,
• Other: 11%

The respondents said they preferred live learning (65%) over print (8%) and on the demand/web learning (27%) formats.

“The limitations of our study include a self-selecting group of respondents who chose to click through our link, and an overall low response rate,” Malter said. However, a study strength was that the respondents represented “the changing landscape of IBD providers,” the researchers wrote.