Are Gastroenterologists Complying with the Preventive Care Guidelines for Inflammatory Bowel Disease?

Introduction: Preventive care guidelines for Inflammatory Bowel Disease (IBD) emphasize the need of health maintenance as part of the IBD care to prevent complications related to immune suppressive or modulating therapies. Proper documentation of vaccinations and screening tests for IBD may increase high value care in these patients. There is no data about compliance with preventive care among gastroenterologists in Puerto Rico. This study aims to describe various aspects of current preventive care in the IBD clinic. We are reporting the findings related to documented preventive care offered to patients. Methods: This is a cross-sectional 3-phase study that includes a retrospective medical record review, an anonymous survey of gastroenterologists, and an anonymous survey of patients. To assess physician compliance with the documentation of preventive care guidelines, a retrospective record review was performed. The IBD Clinic Electronic Health Record (EHR) was used to assess the medical record of 201 patient follow up visits from May 2017 to May 2019. A record review questionnaire without identifiers was used to collect data regarding indicated vaccines, cervical, colon and skin cancer screening and screening for osteoporosis, latent tuberculosis (TB), smoking, anxiety, and depression. The study is approved by the MSC IRB. Results: 201 records were reviewed. Colon and cervical cancer screening and smoking status were reported in more than 50% of the visits. Regarding colon cancer screening, extensive colitis >8 years, surveillance colonoscopy performed every 1-3 years and presence of risk factors for colon cancer were documented in 91.4%, 89.6% and 56.7% of records respectively. For cervical cancer screening, immunosuppression in women was documented in 93% of visits, however performance of PAP smear was only documented in 18% of indicated patient visits. Smoking status or cessation therapy was documented in 60.2% of visits. 38.3% of visits contained documentation of the risk factors for osteoporosis, however only in 8% of visits the DXA scan status was documented. No documentation regarding vaccination status and TB screening was found in over 75% of visits. Conclusion: Our study exposed the frequent lack of documentation about IBD preventive care by gastroenterologists in our clinics. This, together with the results of our study on the knowledge of patients and gastroenterologists will point out other areas for improvement and increase awareness about preventive care in IBD patients.