Gastroenterologists' attitudes and self-reported practices regarding inflammatory bowel disease

Andrea Altschuler, Bernadette Collins, James D. Lewis, Fernando Velayos, James E. Allison, Susan Hutfless, Liyan Liu, Lisa J. Herrinton

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Background: The purpose was to assess organization-, physician-, and patient-based aspects of inflammatory bowel disease (IBD) practice variation within an integrated care delivery system and the extent to which physicians are interested in adopting a chronic care model and/or nurse assistance to manage IBD patients. Methods: As part of an observational cohort study to understand variation in IBD care and outcomes, we conducted semistructured, open-ended interviews with 17 gastroenterologists and 1 gastroenterology registered nurse at 6 clinics in an integrated care delivery system. Interviews were taperecorded and transcribed. We coded and analyzed transcripts using standard qualitative methods. Results: Physicians reported a range of attitudes and practices regarding IBD. Analysis showed differences in 3 domains and 8 subdomains: 1) patient education and choices, including health education and patient use of complementary and alternative medicine; 2) decisions about diagnosis and treatment, including practice guidelines, conferring with colleagues, using infliximab, and medical hospitalization; and 3) organizational aspects of care, including primary care involvement with IBD and MD attitudes toward ancillary support. Conclusions: Standardized algorithms on care for IBD patients do not exist, but opportunities may exist to improve IBD care by: having initial work-ups and management of patients in remission in primary care; creating and maintaining opportunities for gastroenterologists to confer with colleagues and acknowledged local experts; and having nurse coordination for medications and labs and/or some type of specialty IBD clinic for high-need patients. This research highlights the need for more directed comparative efficacy and effectiveness trials that will serve to define preferred treatment strategies.

Original languageEnglish (US)
Pages (from-to)992-999
Number of pages8
JournalInflammatory bowel diseases
Issue number7
StatePublished - Jul 1 2008
Externally publishedYes


  • IBD
  • Organizational aspects of care
  • Practice variation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology


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