Implementing guidelines on the prevention of opportunistic infections in inflammatory bowel disease

Walsh A.J., Weltman M., Burger D., Vivekanandarajah S., Connor S., Howlett M., Radford-Smith G., Selby W., Veillard A.S., Grimm M.C., Travis S.P.L. and Lawrance I.C. (2013) Implementing guidelines on the prevention of opportunistic infections in inflammatory bowel disease. Journal of Crohn's and Colitis, 7 10: e449-e456. doi:10.1016/j.crohns.2013.02.019

Author Walsh A.J.
Weltman M.
Burger D.
Vivekanandarajah S.
Connor S.
Howlett M.
Radford-Smith G.
Selby W.
Veillard A.S.
Grimm M.C.
Travis S.P.L.
Lawrance I.C.
Title Implementing guidelines on the prevention of opportunistic infections in inflammatory bowel disease
Journal name Journal of Crohn's and Colitis   Check publisher's open access policy
ISSN 1873-9946
Publication date 2013-11-01
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.crohns.2013.02.019
Open Access Status DOI
Volume 7
Issue 10
Start page e449
End page e456
Total pages 8
Place of publication Amsterdam, Netherlands
Publisher Elsevier BV
Formatted abstract
Introduction: Opportunistic infections are a key safety concern in the management of patients with inflammatory bowel disease (IBD). Despite the existence of international guidelines, many gastroenterologists have not adopted routine screening and vaccination. The aim of this study was to modify clinical behaviour by use of a simple screening tool.

Methods: A screening and vaccination proforma for hepatitis B, varicella, Influenza, Pneumococcus, human papillomavirus, tuberculosis, hepatitis C and HIV was provided to each participating gastroenterologist. Gastroenterologists were surveyed for awareness of vaccine recommendations and current practice prior to and following the introduction of the proforma. Rates of immunity and the proportion of patients receiving the recommended screening and vaccinations were documented.

Results: 30 gastroenterologists at 8 different IBD centres took part in the assessment. A total of 919 patients were included (55% female, 65% Crohn's, 33% ulcerative colitis, 2% indeterminate IBD). Introduction of the proforma increased self-reported gastroenterologist screening from 47% to 97% pre- and post-intervention respectively, p. <. 0.001. After the proforma was applied, vaccination against hepatitis B, varicella, Influenza, and Pneumococcus was recommended in 67%, 2.5%, 75% and 69% of the patients respectively. Of these, 42%, 39%, 66% and 49% patients followed the recommendations and were vaccinated. Cervical smears were recommended in 31%, with 62% of these obtaining the recommended cervical smear.

Conclusions: Implementation of a screening and vaccination proforma significantly changed gastroenterologist self-reported behaviour. Patient compliance with these recommendations was not optimal and suggests the need for further patient education, in addition to other forms of support.
Keyword Implementing guidelines
Inflammatory bowel disease
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
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Created: Fri, 29 Nov 2013, 05:42:03 EST by System User on behalf of School of Medicine