P757 Focusing on the future: Reducing barriers and improving access to inflammatory bowel disease specialty care across Canada

C.G. Heisler1, R. Mirza2, O. Kits3, S. Zelinsky4, S. Veldhuyzen van Zanten5, G. Nguyen6, J. McCurdy7, M. MacMillan8, P.L. Lakatos9, L. Targownik6, S. Fowler10, K. Rioux11, J. Jones12

1QEII Health Sciences Centre, Digestive Care & Endoscopy, Halifax, Canada, 2University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Canada, 3Dalhousie University, Research Methods Unit, Halifax, Canada, 4Patient-Research Partner, Patient-Research Partner, 100 Mile House, Canada, 5University of Alberta, Medicine, Edmonton, Canada, 6University of Toronto, Medicine, Toronto, Canada, 7University of Ottawa, Medicine, Ottawa, Canada, 8Dalhousie University, Medicine, Fredericton, Canada, 9McGill University, Medicine, Montreal, Canada, 10University of Saskatchewan, Medicine, Saskatoon, Canada, 11University of Victoria, Medicine, Victoria, Canada, 12Dalhousie University, Medicine, Halifax, Canada

Background

Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disease which affects nearly two million North Americans, with Canada demonstrating the highest age-adjusted incidence and prevalence rates globally. Resulting from compounding prevalence and limited resources, timely access to IBD care continues to be a widespread issue for patients and healthcare providers. Despite this pervasive issue, there has been no published research to date elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada. The aim of the study was to elicit a qualitative stream of data to better understand phenomena related to access to IBD care from a patient-centered perspective.

Methods

Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. To ensure geographic diversity and representation, patients were recruited from both urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member involved in their care to the focus groups. Co-facilitated by a researcher and patient-research partner, all focus groups were audio recorded, transcribed verbatim, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences in relation to IBD care access.

Results

Sixty-three participants were recruited in 14 focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Thematic analyses identified four main barrier themes, each with multiple sub-themes: (1) structure/system issues (i.e. system stagnation), (2) processes (i.e. information management), (3) experiences (i.e. psychosocial support), and (4) patient as partner (i.e. autonomy, power dynamics). In response, four solution themes were proposed: (1) integration of holistic care into the clinical practice, (2) readily accessible psychosocial and nutritional support, (3) increased patient advocacy, and (4) continuity and liaison through provision of a healthcare navigator resource.

Conclusion

The complexity of IBD specialty care access cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in can be better understood and improved on both a national and international scale.