The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care

Holly Mathias; Noelle Rohatinsky; Sanjay K Murthy; Kerri Novak; M Ellen Kuenzig; Geoffrey C Nguyen; Sharyle Fowler; Eric I Benchimol; Stephanie Coward; Gilaad G Kaplan; Joseph W Windsor; Charles N Bernstein; Laura E Targownik; Juan-Nicolás Peña-Sánchez; Kate Lee; Sara Ghandeharian; Nazanin Jannati; Jake Weinstein; Rabia Khan; James H B Im; Priscilla Matthews; Tal Davis; Quinn Goddard; Julia Gorospe; Kate Latos; Michelle Louis; Naji Balche; Peter Dobranowski; Ashley Patel; Linda J Porter; Robert M Porter; Alain Bitton; Jennifer L Jones

doi:10.1093/jcag/gwad007

The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care

J Can Assoc Gastroenterol. 2023 Sep 5;6(Suppl 2):S111-S121. doi: 10.1093/jcag/gwad007. eCollection 2023 Sep.

Authors

Holly Mathias¹, Noelle Rohatinsky², Sanjay K Murthy^{3

4}, Kerri Novak⁵, M Ellen Kuenzig^{6

7}, Geoffrey C Nguyen⁸, Sharyle Fowler⁹, Eric I Benchimol^{6

7

10

11

12}, Stephanie Coward^{5

13}, Gilaad G Kaplan^{5

13}, Joseph W Windsor^{5

13}, Charles N Bernstein^{14

15}, Laura E Targownik¹⁶, Juan-Nicolás Peña-Sánchez¹⁷, Kate Lee¹⁸, Sara Ghandeharian¹⁸, Nazanin Jannati¹⁷, Jake Weinstein^{6

7}, Rabia Khan^{6

7

10}, James H B Im^{6

7}, Priscilla Matthews¹⁹, Tal Davis^{6

7}, Quinn Goddard^{5

13}, Julia Gorospe^{5

13}, Kate Latos¹⁸, Michelle Louis¹⁸, Naji Balche¹⁸, Peter Dobranowski¹⁸, Ashley Patel¹⁸, Linda J Porter¹⁸, Robert M Porter¹⁸, Alain Bitton²⁰, Jennifer L Jones²¹

Affiliations

¹ School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
² College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
³ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁴ The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
⁵ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁶ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁸ Mount Sinai IBD Centre of Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
⁹ Department of Gastroenterology and Hepatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁰ ICES, Toronto, Ontario, Canada.
¹¹ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹² Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹³ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
¹⁴ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁵ University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
¹⁶ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁸ Crohn's and Colitis Canada, Toronto, Ontario, Canada.
¹⁹ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
²⁰ Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada.
²¹ Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56-66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.

Keywords: Disease monitoring; Integrated care models; Person-centered care; Quality of care; eHealth.

Publication types

Review