An integrated model of care for inflammatory bowel disease sufferers in Australia: development and the effects of its implementation

Inflamm Bowel Dis. 2012 Aug;18(8):1573-81. doi: 10.1002/ibd.22850. Epub 2011 Dec 16.


Background: Psychological comorbidities are associated with poor outcome and increased healthcare utilization in patients with inflammatory bowel disease (IBD). However, a model of care addressing the biopsychosocial dimension of disease is not routinely applied in IBD. This review describes the development of such a model and the effects of its implementation in a hospital-based cohort of patients with IBD.

Methods: Three different approaches were used: 1) collecting baseline epidemiological data on mental health comorbidities; 2) raising awareness of and targeting mental health problems; 3) examining the effects of the model implementation.

Results: High rates of anxiety and depressive symptoms (36% and 13%, respectively) that are maintained over time were identified in IBD patients presenting at a metropolitan teaching hospital. Patients with documented psychological comorbidities were more likely to be hospitalized than those without (odds ratio [OR] = 4.13, 95% confidence interval [CI]: 1.25, 13.61). Improvements in disease activity, anxiety, depression, quality of life, and coping have been noted when cognitive-behavioral therapy (CBT) was provided to patients. A drop in the use of opiates (P = 0.037) and hospitalization rates (from 48% to 30%) in IBD patients has been noted as a result of introduction of the changed model of care. In addition, the mean total cost of inpatient care was lower for IBD patients than controls (US$12,857.48 [US$15,236.79] vs. US$ 30,467.78 [US$ 53,760.20], P = 0.005).

Conclusion: Our data to date suggest that an integrated model of care for patients with IBD may yield superior long-term outcomes in terms of medication use and hospitalization rates and reduce healthcare costs.

Publication types

  • Review

MeSH terms

  • Australia
  • Delivery of Health Care, Integrated*
  • Health Care Costs
  • Hospitalization*
  • Humans
  • Inflammatory Bowel Diseases / economics
  • Inflammatory Bowel Diseases / psychology
  • Inflammatory Bowel Diseases / therapy*
  • Stress, Psychological / psychology*