Implementation of screening- and treatment tools in an outpatient setting
Aim: To evaluate the process of introducing screening tools and treatment algorithms' for anaemia: detection, management and monitoring for IBD patients in an outpatient setting. Background: Prevalence of anaemia among IBD patients have wide estimates (8,8 % - 73,7%). A reduced production of erythrocytes due to inflammatory inhibition of the bone marrow (chronic inflammatory anaemia) and/or lack of "building material" such as iron, folate or Vitamin-B12 are often found in IBD patients - especially Crohn´s disease patients. Furthermore blood loss due to gastrointestinal bleeding is seen. Anaemia due to iron deficiency can be treated with oral- or intravenous iron replacement. To systematize management of anaemia in IBD patients' different tools has been developed at Aarhus University Hospital since 2006. Patients and Methods: Data related to 111 IBD-patients treated with intravenous iron at Aarhus University Hospital from August 2005 until October 2009 was used. A structured treatment plan and monitoring form were evaluated. The treatment plan contained treatment target (haemoglobin) based on results of blood samples. The patients' individual treatment plan was completed by IBD-physicians. The monitoring form include registration of vital signs, administration of intravenous iron, quality of life assessments (QoL), disease activity and scheduled blood samples monitoring status of the anaemia. The monitoring form was completed by IBD nurses. Results: Results based on a sample of one third of the patients' indicates a nearly 100% completion of blood samples taken for screening and treatment plan calculation. Disease activity and QoL were calculated for less than 50% of the patients at the start of anaemia treatment. Nevertheless the monitoring form was used for every visit, where intravenous iron was given. Conclusion: A systematic screening and treatment plan has been implemented almost 100%. The monitoring form was used 100%, but repeated assessments of disease activity and QoL were only performed for a minority of patients'; this could be due to frequent visits (2 times per week) or inadequate introduction of the tool in the organisation. The introduction of systematic tools' for managing IBD-anaemia led to increased focus on an often overlooked problem.
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Congress of ECCO - Inflammatory Bowel Diseases 2010