Guided
Self-Management in Ulcerative Colitis:
Better Treatment and More Efficient Use of Health Services
Authors:
Andrew
Robinson - clinical lecturer in gastroenterology
David
Thompson - professor of gastroenterology
David
Wilkin - professor of health service research
Section
of Gastroenterology
The University of Manchester
Clinical Science Building
Hope Hospital
Stott Lane
Salford
M6 8HD
Address
for correspondence:
National Primary Care Research and Development Centre
5th Floor
Williamson Building
The University of Manchester
Manchester
M13 9PL
Telephone: 0161 275 7601
Fax: 0161 275 7600
Abstract
Summary
Guided
self-management in ulcerative colitis can reduce the number
of doctor-patient contacts by two-thirds and improve the
quality of care received. This has enormous implications
for the management of this disease and the organisation
of clinical follow-up.
Background
Chronic
diseases account for 14 million out-patient visits per year
in England but these illnesses may not be best managed by
regular clinic review:
1)
Disease activity rarely corresponds with clinic visits
2)
There are frequently delays between symptoms and treatment
3)
Clinics full of patients with inactive disease make it more
difficult to see urgent follow-ups and new referrals. An
alternative strategy has been assessed in the management
of ulcerative colitis.
Trial:
203 patients receiving long-term hospital follow-up for
ulcerative colitis were randomised to one of two groups.
Group
1 (101 subjects) were instructed to treat their symptoms
in the event of a flare-up and to telephone for an urgent
appointment if their symptoms could not be controlled within
a few days. No routine follow-up visits were provided. Any
blood tests needed to monitor therapy were carried out in
the primary care centre.
Group
2 (102 controls) received treatment and follow-up as usual.
Results
1)
Patients in the self-treatment group required 88 clinic
visits (mean 0.87/patient) and the control patients required
297 clinic visits (mean 2.91/patient).
2)
The delay between symptoms and treatment was reduced from
a mean of 4 days for controls to under 24 hours for subjects.
Patient costs were significantly reduced and only 2 out
of 101 patients preferred the old system of treatment and
follow-up when offered the choice.
Conclusions
Teaching
patients to manage flare-ups themselves results in earlier
treatment, less doctor visits and is preferred by patients.
All patients with colitis should be offered self-management
training.
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