Quality of Care for Patients With Inflammatory Bowel Disease From a Brazilian Public Healthcare Center Using the Questionnaire QUOTE-IBD
BACKGROUND: The Inflammatory Bowel Diseases (IBD), which comprise Crohn’s Disease (CD) and Ulcerative Colitis (UC) are chronic diseases that demand continuous interaction between patients and the healthcare centers. The quality of care (QC) is a factor that interferes in adherence and contributes to the success of the treatment. The aim of the study was to evaluate the QC of a single Brazilian IBD reference center using the “Quality of Care through the eyes of patients with Inflammatory Bowel Disease” questionnaire (QUOTE-IBD).
METHODS: Cross-sectional study including 133 patients with confirmed IBD (CD or UC) from a single IBD Center (Hospital das Clínicas de Botucatu) of São Paulo State, Brazil. Disease activity was evaluated through Crohn’s Disease Activity Index (CDAI) and Mayo Score, in CD and UC patients, respectively; quality of life, using IBDQ questionnaire; and QC, through the QUOTE-IBD questionnaire. The QUOTE-IBD tool relies on both Importance (I) and Performance (P) and evaluates: autonomy, accessibility, accommodation, costs, courtesy, competence, continuity of care and information. It is graded 0 to 10, being considered satisfactory if graded 9 or above. Statistical analysis: descriptive statistics and Pearson correlation.
RESULTS: 133 patients were interviewed (69 CD and 64 UC), the average age was 37.26 ± 13.05 years and 62.91% were women. The mean duration of the disease was 8.44 ± 7.59 years and most patients were in remission in both the UC (70.31%) and the CD (62.32%) groups; 39.10% of patients were in use of biological therapy. According to the IBDQ classification, 64.39% presented a good or excellent quality of life. Despite this, 40.46% of patients had anxious manifestations and 29.01%, depressive symptoms. Regarding the healthcare evaluation, the total QC measured by QUOTE-IBD was 8.61 ± 1.31 points, placing it as unsatisfactory. The categories that reached satisfactory results were autonomy (9.37 ± 2.08), courtesy (9.27 ± 1.31), and cost (9.48 ± 1.93). The top-rated questions were: professionals' understanding of complaints (9.95 ± 0.37), professional’s ability to consider the patient's opinion seriously (9.82 ± 0.96), trust in the physician (9.68 ± 1.73) and the use of understandable terms (9.51 ± 2.04). The items with lower scores were: possibility of contacting the doctor by telephone (6.72 ± 3.77), conditions of the hospitals’ toilets (6.86 ± 4.50), possibility of having a specialist consultation within 2 weeks after being referred to him/her (7.37 ± 3.62) and the statement “doctors should inform me clearly about other possible physical problems because of IBD” (7.37 ± 4.10). The variables associated with a better total score on the QUOTE-IBD were: being carrier of CD (R = 0.24; P = 0.0042), infliximab use (R = 0.22; P = 0.0101) and use of biological therapy (R = 0.19; P = 0.0299).
CONCLUSION(S): The service was well evaluated, mainly for a good doctor-patient relationship, but still has problems to be solved, especially those related to the healthcare structure. Service quality assessment leads to the identification of health care domains that might need improvement, both at individual care aspects (e.g., information about nutrition, autonomy) and at general dimensions of care (e.g., accessibility and competence). Thus, it is essential for quality of life improvement among IBD patients.
