This page contains a Flash digital edition of a book.
SUMMARY, CHALLENGES AND RECOMMENDATIONS


Diagnosis


The evidence suggests that late diagnosis and inappropriate investigation and management are substantial problems with IBD. Spray et al.153


found, based on referrals to specialists, a


median delay of 47 weeks for CD and 66 weeks for those without diarrhea; in UC the median was 20 weeks but was three years in the worst cases. A similar study for children only had similar findings (7.1 months for CD and 6.7 months for UC).153 conducted by Rath et al.154


In terms of symptoms, a study year between onset of symptoms and diagnosis. Pimentel et al.155


found that 38% of CD patients had an interval of more than a found people could be


symptomatic for years before diagnosis (a prodromal period of 7.7±10.7 years for CD and 1.2±1.8 years for UC), due to insidious onset as well as delays after presentation.


• Patients may be slow to present in part due to lack of information/awareness and stigma (Grandbastien et al.156


).


• Symptoms may mimic functional disease (IBS) leading to misdiagnosis and delays. • There can be a lack of awareness within the primary care community and emergency departments, which can impede diagnosis. At least some of the delay in diagnosis is due to the patient and the primary care physician not recognizing the symptoms, which further emphasizes the importance of education.


• Differential diagnosis may be difficult for CD and UC. • Not only do CD and UC elevate the risk of colorectal cancer but their symptoms can delay a diagnosis of colorectal cancer.


• IBD is increasing in incidence, so health professionals may not have seen much of it previously.


• Access to endoscopy, gastroenterologists and radiology shows significant regional variation making it difficult for some Canadians to be assessed in a timely fashion.


• Access to gastroenterologists (i.e. medical specialists in gastrointestinal disease) is likely to get worse in Canada for the foreseeable future. Demographics indicate that greater numbers of these specialists are approaching retirement and limited training and residency opportunities drive this trend.158


Timely and Equitable Access to Treatment


• Equal and timely access to clinically appropriate medications is vital to persons living with IBD. In Canada, drug plan formulary decisions are based on the pharmoecononic evaluations conducted by the Common Drug Review and provincial drug plans. However, the current system leads to untimely and inequitable access to medications across the country that is not based on patients’ needs but a reflection where people live and their financial means.


• Recent treatment options can help prevent hospitalizations and improve health outcomes and quality of life for people with IBD. Unfortunately, many of these therapies are expensive and may not be available, or have restricted access, through provincial drug plans.


• The cost of pharmaceuticals can be prohibitive, and there is significant variability in access to and coverage for vital medications between provincial formularies, forcing some patients into surgeries (with their associated impacts) that might otherwise be avoidable.


• Biological therapies, in particular, pose significant access issues due to their high cost. Access and coverage may depend on the insurance status of the patient – those with private health insurance may be able to obtain a limited supply – while those without, depend on variable provincial drug plans.


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 83


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96