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Observational Study
. 2023 Nov 1;35(11):1263-1269.
doi: 10.1097/MEG.0000000000002642. Epub 2023 Sep 18.

Potential missed diagnoses of Crohn's disease in tertiary care: impact on drug utilization and healthcare facilities use

Sara Ferraro  1 , Emiliano Cappello  1 , Claudia Bartolini  2 , Irma Convertino  1 , Lorenzo Bertani  3 , Ersilia Lucenteforte  4 , Francesco Costa  5 , Olga Paoletti  3 , Sabrina Giometto  4 , Rosa Gini  2 , Marco Tuccori  1   6
Affiliations
Observational Study

Potential missed diagnoses of Crohn's disease in tertiary care: impact on drug utilization and healthcare facilities use

Sara Ferraro et al. Eur J Gastroenterol Hepatol. .

Abstract

Background: A missed diagnosis of Crohn's disease (CD) can delay treatment initiation with consequences on disease course.

Aims: To measure the possible impact of missed diagnoses on drug utilization and access to healthcare facilities in a real-world cohort of CD patients.

Methods: This retrospective observational study has been conducted on the regional administrative databases of Tuscany (Italy). We included patients with a first record of CD diagnosis between 06/11/2011 and 06/30/2016. Possible missed diagnosis (exposure) was defined by hospital presentation for gastrointestinal symptoms consistent with CD diagnosis that occurred in the 7-60 months preceding CD diagnosis. We compared exposed and non-exposed patients by assessing time-free from biologic drugs and from Emergency Department (ED) or hospital access. Hazard ratio (HR) was calculated using Cox models.

Results: Among 3342 CD patients, 584 (17.5%) had a possible missed diagnosis. A risk of being treated with biologic drugs [adjusted HR (aHR): 2.17, 95% CI: 1.75-2.71] and of access to ED or hospitalization (aHR: 1.59, 95% CI: 1.44-1.75) was observed in patients with a possible missed diagnosis as compared to those without.

Conclusion: Tertiary care caregivers should be trained in the identification of early CD symptoms, to timely identify CD diagnosis and optimize pharmacological treatment and disease management.

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