Anyone can build a successful inflammatory bowel disease (IBD) practice. To do so requires commitment and focus in the area of IBD including both Crohn’s disease and ulcerative colitis. It also requires a fundamental knowledge of medicine as well as a desire to excel and learn all that one can in these areas. Given the high number of stakeholders, good interpersonal skills are vital. Establishing an IBD practice provides an opportunity to make a big difference in peoples’ lives and the age range of impact is about the broadest in all of medical practice. The more resources you have, the greater the potential impact of your care. Table 1 lists resources that are useful to provide optimal IBD patient care.
Dr. Doug Wolf
You, the gastroenterologist, is the most important resource for the patient. Medical school, residency, fellowship, and “postgraduate” training serves as the foundation for your wealth of knowledge. Maximizing your training is of value, and this can be done by being part of an academic program, keeping abreast of current literature, and attending meetings and post-graduate courses. AGA offers a variety of publications (http://www.gastro.org/journals-and-publications) and continued training opportunities (http://www.gastro.org/education).
One further point regarding scheduling is that one must be willing and able to see patients urgently, rather than sending them to the emergency room. ERs are appropriate for true emergencies, but are not an ideal place for care when an IBD patient has a flare and requires prompt follow-up. I try to avoid ER visits for my patients unless they are vomiting, have severe abdominal pain, significant bleeding or have clear signs of toxicity. In an ER, abdominal pain equals a CT scan; one should consider seeing these patients in the office and triaging accordingly.
With the increasing requirements of managed care and restrictive medical plans, there has been a similar rise in the frequency of diagnostic test as well as procedure and medication denials. Re-approval and recertification of biologics and other medications have become common, which can add a great deal to your workload and that of your staff. Integration of endoscopy, pathology, and imaging (e.g., ultrasound, CT/CTE) improves response time, dialogue, and can have a positive impact on care. Office infusion allows for a better integration of this service into your practice. There is typically better communication with the infusion nurse(s) and better expedited care as well as fewer cancellations for minor infections. This all helps avoid infusion procedure delays. Infliximab, vedolizumab, ustekinumab, and lyophilized certolizumab pegol as well as intravenous iron administration can also expand services and enhance quality.
Having a medical assistant, nurse, and others in your practice to assist with patient services and care is a must. There will be many phone calls, emails, and other interactions regarding appointments, consults, routine lab testing, radiology testing, standard medications, biologics, and other treatments that necessitate an effective team-approach. For this role, either a nurse or an experienced medical assistant would be well-suited. Additional support staff and services can also aid our IBD patients. A dietitian knowledgeable in IBD and practical dietary options can, in many instances, prove invaluable. Understanding and utilizing pharma-sponsored “Patient Assistance Programs” provides drug access for the 10-20% (or more) of patients who do not have insurance or biologic coverage. Having specialty access and collegiality with colorectal surgeons, general surgeons, OB/GYNs, dermatologists, hematologists, oncologists, and others is important to expedite consults and provide collaborative care. Finally, offering clinical research options improves access for patients with limited and no coverage and also helps provide needed options for all IBD patients.
This brief overview has hopefully given you some insight into how to provide a higher level of evaluation and care for our IBD patients. These approaches have allowed me to build and maintain a successful IBD practice, and I hope that the integration of some or all of these strategies help you to build and sustain a successful IBD practice.
Dr. Wolf is director of IBD research, Atlanta Gastroenterology Associates.
