P553 Factors related to steroid consumption in IBD patients: Evidence from a multicenter Study
Barkan, R.(1); Shpoker , L.(2);Abboud, R.(2);Nafrin, S.(3);Ganon , M.(4);Ilsar , T.(4);Volf , T.(5);Markovitch , L.(6);Saban , M.(7);Kagan, I.(8);
(1)Rabin Medical Center - Beilinson Hospital, IBD Center- Division of Gastroenterology, Petah Tikva, Israel;(2)Bny Zion- Medical Center, IBD Center- Division of Gastroenterology, Haifa, Israel;(3)Hillel Yaffe Medical Center, . IBD Center- Division of Gastroenterology, - Hadera, Israel;(4)Hadassah Ein Kerem Medical Center, IBD Center- Division of Gastroenterology, Jerusalem, Israel;(5)Shamir Medical Center, IBD Center- Division of Gastroenterology, Tzrifin, Israel;(6)Rabin Medical Center - Hasharon Hospital, IBD Center- Division of Gastroenterology, Petah Tikva, Israel;(7)Gertner institute, for epidemiology and health policy research, Ramat-Gan, Israel;(8)School of Health Professions- Sackler Faculty of Medicine- Tel Aviv University, Nursing Department-, Tel Aviv, Israel
Steroids are frequently used to induce remission in inflammatory bowel disease (IBD) but should not be used as maintenance treatment. Understanding the factors related to steroid consumption is essential in order to avoid over prescription of these drugs.
A cross-sectional study was conducted between 2019 and 2020 in six medical centers in Israel. Data was collected using a structured self-administered tool containing the following: socio demographic and clinical characteristics, knowledge of side effects and complications of steroid treatment, self-care and compliance with medical instructions, Steroid Assessment Tool (SAT) and objective physiological measures.
The study included 402 IBD patients; 262 patients with Crohn's disease (CD) (66%) and 135 patients with ulcerative colitis (UC) (34%). Most of the patients reported being monitored in the IBD unit in the medical centers (87.7%). A quarter of the patients (n=88) had been prescribed systemic steroids over the previous year, and 20 (23%) received 3 or more prescriptions for systemic steroids over the preceding year. Likewise, over 20% of patients were on systemic steroid therapy for over 4 months in the preceding year. Those patients were mostly men and ultra-orthodox. Patients with UC were prescribed steroids more often than CD patients. Knowledge levels regarding appropriate steroid consumption were significantly higher among women (F=40.24, p<.001) and lower among ultra-orthodox patients (X2=6.43, p<.05). Although most of the patients (85.9%) were routinely treated by gastroenterologist, the majority (80%) choose to visit the general practitioner when their disease had flared up.
Several factors were found to be related to inappropriateness use of steroids in IBD patients. Thus, tailored intervention for specific population should be developed to ensure that steroids are used correctly and that their side effects are minimized. Also, infrastructure and alignment of an integrated health care delivery system, with multidisciplinary team may provide the optimal environment for care coordination, especially during disease flare.