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Changes in Hospital Care for Children With IBD Across Australia From 2014 to 2022
Laura Rishanghan1, David Skvarc2, Stefan Moller3
1Department of Gastroenterology, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia.
Insights
Paediatric inflammatory bowel disease (pIBD) hospital admissions in Australia significantly increased from 2014 to 2022, particularly for ulcerative colitis. While medication use shifted, multidisciplinary care remains insufficient for young patients.
Area of Science:
- Gastroenterology
- Paediatric Medicine
- Health Services Research
Background:
- Inflammatory bowel disease (IBD) is a chronic gastrointestinal condition affecting individuals of all ages.
- Paediatric IBD (pIBD) incidence has globally increased, necessitating an understanding of evolving care trends.
- This study focuses on changes in hospital care for young IBD patients in Australia between 2014 and 2022.
Purpose of the Study:
- To assess trends in hospital admissions for paediatric IBD in Australia.
- To analyze changes in therapeutic approaches and care delivery for pIBD patients.
- To provide data for national planning and resource allocation for pIBD services.
Main Methods:
- Utilized national paediatric IBD admission data from the Australian Institute of Health and Welfare (AIHW).
- Conducted a clinical audit of overnight inpatient admissions for 2021.
- Compared 2021 data with a previous study from 2014.
Main Results:
- Overnight pIBD admissions rose from 590 in 2014 to 813 in 2021.
- Ulcerative colitis admissions doubled, while Crohn's disease and surgical admissions remained stable.
- Reduced corticosteroid use and increased off-label medication use were observed; multidisciplinary team involvement, including psychologists, was inadequate.
Conclusions:
- A significant increase in ulcerative colitis admissions among Australian paediatric IBD patients over the past decade.
- Medication trends align with global patterns, but multidisciplinary care is insufficient.
- Findings underscore the need for improved national planning and resourcing for paediatric IBD care.
Background:
Inflammatory bowel disease is a chronic, lifelong gastrointestinal disorder, with 8%-10% of patients diagnosed < 18 years old. Over the last decade, there has been a global increase in paediatric IBD (pIBD) incidence and changes in therapeutic approaches. Our study aimed to assess the changes in hospital care for young people with IBD from 2014 to 2022.
Methods:
Complete national pIBD data on admissions was collected through the Australian Institute of Health and Welfare (AIHW). Hospitals nationally were invited to participate in a clinical audit of inpatient overnight admissions for 2021. Data was compared to a previous study from 2014.
Results:
There were 813 overnight pIBD admissions in 2021, compared to 590 in 2014. Eight public hospitals participated, with 186 admissions, capturing 23% of all 2021 pIBD admissions. UC admission rates doubled; however, surgical admissions reduced (16% in 2014 to 5% in 2021, p < 0.05). CD and surgical admissions remained stable. There was reduced corticosteroid use, and 56 patients had off-label medication use. Sixty-five percent of patients had active disease at the last clinic review. There was a trend towards shorter admissions, and re-admission rates were similar to previous global data. Despite psychological co-morbidity in 28% of cases, psychologists were not part of the team at any site.
Conclusion:
This study showed a significant increase in UC admissions in Australia over the last decade. Medication changes were in line with global trends, and multi-disciplinary care remained inadequate despite national standards. This data provides evidence for planning and resourcing pIBD care nationally and worldwide.
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