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Implementation of an evidence-based management algorithm for patients with chronic pancreatitis (COMBO trial): study
Florence E M de Rijk1,2, Charlotte L van Veldhuisen3,4,5, Marc G Besselink4,5
1Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. f.derijk@erasmusmc.nl.
Insights
This study evaluated an integrated management algorithm for chronic pancreatitis (CP). The evidence-based approach aims to improve patient quality of life and reduce pain severity in CP patients.
Area of Science:
- Gastroenterology
- Clinical Trials
- Health Services Research
Background:
- Chronic pancreatitis (CP) is an inflammatory condition impacting quality of life and life expectancy.
- Suboptimal long-term management and adherence to guidelines contribute to CP complications.
- Standardizing care may enhance treatment outcomes for CP patients.
Purpose of the Study:
- To evaluate if patient education and standardized care improve quality of life and reduce pain in CP.
- To assess the effectiveness of an evidence-based integrated management algorithm for CP.
Main Methods:
- Nationwide stepped-wedge cluster-randomized controlled trial (COMBO trial).
- 26 centers across 6 health regions transitioned to an evidence-based algorithm.
- Co-primary endpoints: quality of life (PANQOLI) and pain severity (Izbicki questionnaire).
Main Results:
- This section is not available in the provided abstract.
Conclusions:
- This is the first stepped-wedge cluster-randomized controlled trial on this topic.
- Investigates an evidence-based integrated therapeutic approach for CP compared to current practice.
Background:
Chronic pancreatitis (CP) is an inflammatory disease that may be complicated by abdominal pain, pancreatic dysfunction, nutritional deficiencies, and diminished bone density. Importantly, it is also associated with a substantially impaired quality of life and reduced life expectancy. This may partly be explained by suboptimal treatment, in particular the long-term management of this chronic condition, despite several national and international guidelines. Standardization of care through a structured implementation of guideline recommendations may improve the level of care and lower the complication rate of these patients. Therefore, the aim of the present study is to evaluate to what extent patient education and standardization of care, through the implementation of an evidence-based integrated management algorithm, improve quality of life and reduce pain severity in patients with CP.
Methods:
The COMBO trial is a nationwide stepped-wedge cluster-randomized controlled trial. In a stepwise manner, 26 centers, clustered in 6 health regions, cross-over from current practice to care according to an evidence-based integrated management algorithm. During the current practice phase, study participants are recruited and followed longitudinally through questionnaires. Individual patients contribute data to both study periods. Co-primary study endpoints consist of quality of life (assessed by the PANQOLI score) and level of pain (assessed by the Izbicki questionnaire). Secondary outcomes include process measure outcomes, clinical outcomes (e.g., pancreatic function, nutritional status, bone health, interventions, medication use), utilization of healthcare resources, (in) direct costs, and the level of social participation. Standard follow-up is 35 months from the start of the trial.
Discussion:
This is the first stepped-wedge cluster-randomized controlled trial to investigate whether an evidence-based integrated therapeutic approach improves quality of life and pain severity in patients with CP as compared with current practice.
Trial Registration:
ISRCTN, ISRCTN13042622. Registered on 5 September 2020.
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01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include: