Original article 249 Optimizing quality of outpatient care for patients with inflammatory bowel disease: the importance of specialist clinics Joel E.D. Mawdsley, Peter M. Irving, Richard J. Makins and David S. Rampton Background Most patients with inflammatory bowel disease (IBD) undergo long-term outpatient follow up. However, quality of care provided by specialist and non-specialist IBD clinics is rarely critically audited. Objective To compare the standard of outpatient care provided by general gastroenterology and specialist IBD clinics within a single hospital using defined quality criteria. Methods The case notes of 60 consecutive patients with IBD attending general gastroenterology clinics and of 100 patients attending the specialist IBD clinic were reviewed for fulfilment of six quality criteria over the preceding 18 months. Results The proportion of patients fulfilling all six criteria was higher in the specialist IBD clinic. In the specialist IBD clinic, compared with the general gastroenterology clinics, blood tests were performed with appropriate frequency during the initiation of immunosuppressive treatment in 7/11 versus 2/12 patients (P = 0.04) and during maintenance in 24/31 versus 6/21 patients (P = 0.001); bone protection with oral steroids were given to 25/53 versus 4/24 patients (P = 0.01); a screening colonoscopy at 8–10 years was performed in 25/27 versus 11/20 patients with ulcerative colitis (P = 0.004); annual serum urea and creatinine concentrations were measured in 82/89 versus 31/45 patients prescribed 5-aminosalicylates (P = 0.001); annual liver function tests were performed in 96/100 versus 38/60 patients (P = 0.001); and annual haematinics were measured in 37/47 versus 18/33 patients with Crohn’s disease (P = 0.03). Conclusion By these criteria, the specialist IBD clinic provided better care than the non-specialist general gastroenterology clinics. Even in the specialist clinic, however, the care of a minority of patients did not fulfil certain criteria, emphasizing the need for a critical audit of outpatient management of IBD. Eur J Gastroenterol Hepatol 18:249–253 c 2006 Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2006, 18:249–253 Keywords: inflammatory bowel disease, Crohn’s disease, ulcerative colitis, outpatient specialist clinics, quality of care, health resources Centre for Gastroenterology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK Correspondence and requests for reprints to Prof. D.S. Rampton, Endoscopy Unit, Royal London Hospital, London E1 1BB, UK Tel: +44 20 73 77 74 42; fax: +44 20 73 77 74 41; e-mail: d.rampton@qmul.ac.uk Received 20 May 2005 Accepted 13 October 2005 Introduction Although estimates of the exact proportion of patients with inflammatory bowel disease (IBD) under hospital care vary, it is accepted that a substantial percentage undergo long-term follow-up in outpatient gastro- enterology clinics. Rubin et al., in a review of general practitioner records in a population of patients with IBD in northern England, found 30% to be under specialist care [1]. Cheung et al. found the proportion to be much higher in an audit of the management of patients with IBD completed by general practitioners, with two-thirds being reviewed in hospital gastroenterol- ogy outpatient clinics [2]. A third study found that patients with IBD are rarely discharged from outpatient care [3]. The most effective strategy for the outpatient management for patients with IBD is therefore important. There has recently been a trend towards increasing subspecialization within gastroenterology, and it is widely believed that this leads to improved standards of care. Many gastroenterology departments now offer specialist IBD clinics, managed by a consultant with a special interest in IBD and often attended by a specialist IBD nurse. There have, however, been no studies to assess whether quality of outpatient management for patients with IBD differs between specialist IBD clinics and general gastroenterology clinics. In this study we have used criteria based on accepted standard management for patients with IBD to assess the quality of care provided by the specialist IBD clinic and general gastroenterology clinics within our hospital. Our criteria are similar to the recommendations that were later published by The British Society of Gastroenterology 0954-691X c 2006 Lippincott Williams & Wilkins Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.