Search

This prospective service evaluation aimed to determine if integrated psychological support for patients with inflammatory bowel disease (IBD) enhanced outcomes. 75 patients were assessed and treated by a specialist liaison psychiatric service between 2015 and 2017; 43 received psychiatric intervention alone, 32 were referred for psychological intervention by clinical health psychologist; 26 completed this. Pre–post data (n=15 available) included global impression, quality of life, and psychiatric and IBD symptom scores. Referrer/patient satisfaction and cost-effectiveness were retrospectively calculated. Psychological intervention led to reductions in IBD symptoms (ΔSIBD; p=0.003), alongside improvements in depression scores (ΔPHQ-9, p=0.006) and global impression (ΔCGI; p=0.046). Patient/referrer satisfaction was very high. Indicative data comparing service utilisation 1 year before and after engagement found reductions in outpatient appointments and in imaging. This small study suggests consideration of increased access to integrated psychological support services to improve outcomes and gather further evidence of efficacy.

Introduction Growing evidence suggests that psychological stress can increase activity of inflammatory bowel disease (IBD)1,2,3,4. However there is insufficient access to psychological support services for IBD patients in the UK5. Current evidence demonstrates that psychological therapies improve quality of life in the short term, and supports the efficacy of antidepressant medication6 in improving disease activity. Methods Our digestive disease unit at a major teaching hospital secured funding to pilot a Psychological Support Service for Patients with Inflammatory Bowel Disease (PSSPIBD) to provide outpatient psychological support to patients with IBD. Between October 2015 to March 2017, 85 patients were assessed and treated by PSSPIBD, staffed by a psychiatrist (0.1WTE) and clinical health psychologist (0.3WTE) with special interests in IBD. Referrals were made for patients experiencing psychological difficulties related to their IBD by gastroenterologists, IBD nurses, pharmacists and stoma nurses. Results The most common reason for referral into the service was support adjusting to IBD and its symptoms (e.g. pain, fatigue, incontinence, tolerating uncertainty) (55%), followed by anxiety (30%) and depression (10%). 75% of patients seen were female. We demonstrated improvements across a balanced scorecard of four dimensions: clinical effectiveness, service utilisation, patient satisfaction and referrer satisfaction. Clinical effectiveness was measured through the use of validated questionnaires. Short IBD Questionnaire (SIBD) scores pre- and post-psychological therapy showed significant reductions in symptoms across all domains (p=0.003) with notable improvement in systemic symptoms (fatigue and energy levels) and emotional and social functioning. Statistically significant improvements (p=0.003) were seen in Patient Health Questionnaire (PHQ-9) depression score, and there was a strong trend of improvements in anxiety scores, using Generalised Anxiety Disorder Assessment (GAD-7) and quality of life (p=0.061 using Euro-QoL). Patient and referrer satisfaction with the PSSPIBD was very high: 90% of patients and all referrers completing the feedback rated the service as excellent. Initial data comparing service use in one year before and after engaging with PSSPIBD found a statistically significantly reduction in outpatient appointments by 62.5% (p=0.008) and in CT and MRI scans by 76.2% (p=0.05). Conclusions The pilot PSSPIBD demonstrated significant improvements across all domains, notably symptomatology and service utilisation. There should be increased access to integrated psychological support services with further evidence gathered of success across all domains.

At the current level of membership examination fees at the Royal College of Psychiatrists, a resident in psychiatry who passes every part first time pays a total of £2136.[1][1] These costs are intended to cover only expenses rather than to generate profit, a message which many of us have accepted