High incidence of inflammatory bowel disease in northern Australia: A prospective community population-based Australian incidence study in the Mackay-Isaac-Whitsunday region

Background and Aim: Australia has one of the highest incidences of inflammatory bowel disease (IBD) in the world. It is a lifelong inflammatory condition that frequently presents in young adulthood, with significant impacts on morbidity and quality of life. The annual financial cost to Australia exceeds A$3 billion. Thus, it is important to ensure optimal care is delivered to this population. The 2016 Crohn’s and Colitis Australia (CCA) IBD Audit identified the benefits of a multidisciplinary approach to IBD care. Subsequently, the Australian IBD Standards were released in 2016 and recommended service delivery through a specialized IBD team, with specific services provided. Following the original audit, a metropolitan hospital that participated has implemented this model of care, guided by the Australian IBD Standards of 2016. Principal service improvements include dedicated IBD gastroenterologist ward cover and gastroenterology wards, full-time patient helpline support, formalized weekly multidisciplinary team meetings, increased full-time equivalent IBD nurses, and specialist IBD psychology support. This audit aimed to examine patient care and outcomes before and after implementation of the IBD Standards. Methods: This was a single-center, retrospective cohort study of adult patients treated for ulcerative colitis or Crohn’s disease at a metropolitan hospital. Patients were found by searching admissions for the same diagnosisrelated group codes as were used for the 2016 CCA audit, over a 12-month period from 1 December 2017 to 30 November 2018. Included cases were those in which admission was required to treat IBD or its complications. Included patients were 18 years of age or older, with a confirmed diagnosis of ulcerative colitis or Crohn’s disease. The overall size of the IBD service was calculated as the number of patients with at least one visit to the IBD Clinic. The primary outcome of interest was whether creation of an IBD service according to the IBD Standards resulted in an improvement in outcomes assessed in the original 2016 CCA audit. Results were compared with the 2013–2014 data from the same hospital, as well as the national results in the 2016 audit. Results: Overall service size increased markedly from 450 patients with IBD in 2013 to 804 in 2018. Despite this, there was a 28% reduction in admissions for Crohn’s disease, from 46 to 33, and a 15% reduction in ulcerative colitis admissions, from 27 to 22. Mean length of stay for the 2017– 2018 UC cohort was 5.5 days, comparing favorably with the 2013–2014 average of 9.3 and national average in the CCA audit of 8.1 days. Crohn’s disease admissions were similarly shortened, from 7.4 to 4.8 days, with the national average being 7.6 days. The number of patients admitted within 30 days of a previous separation was also reduced. Those with Crohn’s disease admitted in 2017–2018 were less likely to have had presentations in the prior month than in 2013–2014 (9% vs 14%) and less likely than the national average (23%). Ulcerative colitis readmissions were significantly reduced, to only 4.5%, compared with the 2016 national average of 28%. Conclusion: Key IBD outcomes at this facility have improved after practice was closer aligned with the Australian Standards recommendations for an IBD team approach.