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Abstract
Background 2.5 million people in Europe are diagnosed with IBD. IBD affects quality of life, but also has important consequences for health systems. It remains unknown if there are variations in IBD care across Europe and to help address this question, we conducted this European Variation In ibd PracticE suRvey (VIPER) to study potential differences.
Methods This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank).
Results There were 1268 participants from 39 European countries. Most of the participants are specialists (65.3%), followed by fellows in training (>/< 3 years, 19.1%, 15.6%). Majority of the responders are working in academic institutions (50.4%), others in public/district hospitals (33.3%) or private practices (16.3%).
Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p<0.001) the majority of clinicians felt comfortable in treating IBD (77.2% vs 72.0%, p=0.04). Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p<0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p<0.001), which often take place on a weekly basis (53.0%). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p<0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p<0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p<0.001).
On multivariate analysis (Abstract HMO1 Figure 1) GDP was not a factor that dictated confidence in treating patients with IBD. Those that had experienced specific IBD training were more than 3 times more likely to report confidence in treating IBD patients. Furthermore, there was a direct correlation with confidence related to the quantity of patients seen per week with each additional 10 patients improving confidence by a factor of 10. These factors are important as they are easily modifiable targets that can help improve confidence across Europe in managing patients with IBD.
Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%).
Factors associated with confidence on multivariate analysis
Conclusion A lot of variability in IBD practice exists across Europe, with marked differences between high vs low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardise IBD care across Europe.