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. 2020 Jan 24:13:1756284819895217.
doi: 10.1177/1756284819895217. eCollection 2020.

Effect of distance to specialist care for the diagnosis and disease outcome of inflammatory bowel disease in the Swiss inflammatory bowel disease cohort study

Lorenz Grob  1 , Sena Bluemel  1 , Luc Biedermann  1 , Nicolas Fournier  2 , Jean-Benoit Rossel  2 , Stephan R Vavricka  1 , Jonas Zeitz  3 , Gerhard Rogler  1 , Andreas Stallmach  4 , Michael Scharl  5
Affiliations

Effect of distance to specialist care for the diagnosis and disease outcome of inflammatory bowel disease in the Swiss inflammatory bowel disease cohort study

Lorenz Grob et al. Therap Adv Gastroenterol. .

Abstract

Background: Inflammatory bowel disease (IBD) needs early interventions and an individual specialist-patient relationship. Distance from a tertiary IBD center might affect patient's disease course and outcome. We investigated whether the patient-to-specialist distance has an impact on the disease course using the well-defined patient collective of the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS).

Methods: Patient's home address at diagnosis (postal zip code) was extracted from the SIBDCS database. Distance between each zip code and the nearest located IBD specialist center was calculated and classified into the following three sections based on proximity: <10 km (group 1); 10-35 km (group 2); >35 km (group 3).

Results: Our study included in total 408 IBD patients [234 Crohn's disease (CD), 154 ulcerative colitis (UC), 20 IBD unclassified (IBDU)]. Median age was lowest in group 2 at diagnosis (G1: 28 years; G2: 21 years, G3: 26 years, p < 0.01). The diagnostic delay did not differ between groups. CD patients in group 1 were treated more often with anti-tumor necrosis factor (TNF) agents (72% versus 56%, p = 0.04) and 5-aminosalicylates (44% versus 28%, p = 0.04) than in group 3. UC/IBDU patients in group 1 were treated more often with corticosteroids than patients in group 3 (83% versus 58%, p < 0.01). The occurrence of IBD-related surgeries did not differ between groups.

Conclusions: Patient-to-specialist distance might affect drug treatment. However, disease course and the need for IBD-related surgery does not seem to be associated with a longer distance to specialist care in Switzerland.

Keywords: diagnostic delay; disease outcome; tertiary care.

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Conflict of interest statement

Conflict of interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Map of Switzerland with place of residence of the study population and location of specialized health care facilities. Radius in kilometers: 0–10 km yellow, 10–35 km blue, and >35 km orange.
Figure 2.
Figure 2.
Flow diagram for inclusion criteria. SIBDCS, Swiss inflammatory bowel disease cohort study.
See this image and copyright information in PMC

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