Background: This study aimed to describe and compare disease outcomes in rural patients with Inflammatory Bowel Disease (IBD), review perspectives regarding barriers to optimal rural IBD care and define non-gastroenterologist healthcare practitioners’ exposure to and knowledge of IBD. Method and Materials: Rural patients who had previously completed an IBD questionnaire were identified from a tertiary hospital IBD database and matched for disease, age and gender to metropolitan patients from this same database. A further rural IBD cohort was identified from a rural general practice database in Mount Gambier, South Australia. These patients were invited to complete the same IBD questionnaire relating to disease characteristics and a further questionnaire relating to perceived barriers to optimal care. A questionnaire was also sent to rural healthcare practitioners seeking perspectives on IBD practice, knowledge of IBD management and perceived barriers to care for rural IBD patients. Results: No statistically significant difference was found between rural and metropolitan IBD patients identified on the database. Thirty-three Mount Gambier rural patients returned questionnaires (response rate 30%). No significant difference was found between the Mount Gambier rural cohort and the IBD database metropolitan cohort for the majority of disease complications and outcomes; however variance in medication use and access to imaging was found. A total of 233 healthcare practitioners completed questionnaires (response rate 21%). The majority of rural practitioners felt comfortable with managing IBD, yet 80% of general practitioners felt uncomfortable using immunomodulators. Disease knowledge using a validated tool appeared satisfactory. Teleconferencing and information sessions were suggested as possible interventions to overcome the identified barriers. Conclusion: No statistically significant differences in the rate of patient reported disease complications were found. A variance of practice with respect to methotrexate, iron replacement and hydrocortisone therapy and use of MRI was noted. Descriptive data regarding perceived barriers in addition to these findings will help guide future interventions to enable equality of care for patients with IBD living in regional and remote locations.
Bennett AL, Wichmann M, Chi JK, Andrews JM and Bampton PA