Geographic disparities in Healthcare Utilisation in people with inflammatory bowel disease, Crohn's Colitis Cure Data Insights Program.

Abstract

Background: Inflammatory bowel disease (IBD) is a lifelong illness, increasing in prevalence, with Australia (AUS) and New Zealand (NZ) amongst the highest in the world. Long-term management poses significant economic burden on people with IBD and the healthcare system. We aim to describe the healthcare utilisation (HCU) across 18 sites using Crohn's Colitis Care (CCCare) as their IBD electronic management record (EMR). Method(s): CCCare is a cloud based EMR used in Australasia. Data feed into a de-identified clinical quality registry (CQR), which was interrogated in September 2024 to examine HCU over a 12-month period (September 2023 to 2024). People under active care, with a clinical assessment during the last 14 months were included. Descriptive statistics and a negative binomial regression model were used to examine for possible relationships amongst disease and demographic characteristics. Result(s): There were 7506 eligible people, with a median age of 42 years (IQR 31 - 56). There was an even gender distribution (49.0%, n=3679, male) and more than half had Crohn's disease (CD) (55.8%, n=4187), 41.4% (n=3107) ulcerative colitis (UC), and 2.8% (n=212) IBD-Unclassified. The median disease duration was 10.7 years (IQR 5.1 - 19.2). Most resided in AUS (73.1%, n=5487) and 26.9% (n=2019) in NZ. The majority of people resided in a metropolitan area (75.2%, n=4973), with 26.9% (n=1643) in non-metropolitan areas. Patient demographics are presented in table 1. Ambulatory HCU is presented in table 1. Over the past 12 months, there were 10,705 helpline contacts (1.4 pp) and 11,439 (1.5 pp) clinical assessments either in-person or via telehealth. There were notably fewer endoscopic (0.2 pp) and radiology (0.3 pp) events. People with UC received endoscopies at a higher rate, but radiological events at a lower rate than those with CD (both p<0.001). Helpline contacts were also less frequent from people with UC compared to those with CD (p<0.01). Those residing in NZ consistently show lower HCU than in AUS in all HCU measures (p<0.01). Residing in non-metropolitan area is associated with lower use rate of radiology (p<0.05) and clinical assessments (p<0.01), but higher rates of helpline contacts compared to those in metropolitan areas (p<0.001). Conclusion(s): The disparity in HCU suggests unwarranted variation in care or disparities in resource allocation creating inequities in health outcomes and access to care. The significant difference in HCU between countries and regions requires further correlation with healthcare outcomes. Identifying the most cost-effective approach to care that also improves patient outcomes will ultimately optimise health outcomes and advance value-based healthcare models for IBD management.