Creating an IBD Collaborative System of Care: 6 Key Elements From Dr. Vera Denmark
Vera Denmark, MD, is the medical director of Inflammatory Bowel Disease Research at Newton Wellesley Hospital in Massachusetts. Dr. Denmark completed her gastroenterology fellowship at Mount Sinai Hospital in New York, a large IBD center. She went on to join the Mount Sinai medical staff and conducted laboratory bench research on IBD. In 2013, she joined Newton Wellesley Hospital as its first medical director of IBD research. Here, Dr. Denmark shares six key elements to the clinical IBD center she is creating from scratch.
1. Research. When Dr. Denmark came aboard, the hospital had limited research capabilities. Right now, Dr. Denmark and her team at the IBD center are in the process of starting a research program in conjunction with Massachusetts General Hospital in Boston. "We are starting to enroll patients in a clinical database. The data will be used for multiple studies," she says. Armed with data, Dr. Denmark hopes to increasingly gain the ability to treat more complicated IBD cases.
2. Multidisciplinary approach. The IBD center currently includes six gastroenterologists, in addition to two colorectal surgeons. Each physician has an area of interest relating to irritable bowel disease. In addition to the GI physicians, the center includes a nutritionist with a focus on gastroenterology. Dr. Denmark hopes to expand the multidisciplinary care available to the patients at the center with addition of psychologists.
3. Centralized service. Most IBD patients can be cared for on an outpatient basis, while only the very sick require hospitalization or inpatient surgery. The IBD center is located on the hospital campus, but the center itself includes physician offices, an endoscopy suite and Remicade infusion capabilities. It is easy for the patient to go from the office to the endoscopy suite. Everything is under one roof, says Dr. Denmark.
4. Patient transition. IBD is often seen in teenagers or patients in their early 20s. Younger patients are often treated by a primary care physician or community GI physician and later referred to a new physician, leaving a gap in care. Dr. Denmark and her team are in the process of putting in place a program to transition patients from pediatric care to adult IBD treatment. A patient's last visit with a pediatric physician will take place with the new adult physician. The providers and patient are on the same page and allowed to feel comfortable about the course of care.
5. Shared decision-making. "Pediatric patients are definitely a separate category of patients. They are learning how to be in control of medical decisions. There is a different level of maturity," she says. Taking this into consideration, the IBD center physicians ensure constant interaction with parents. Physicians and parents engage in discussions to help younger patients make difficult therapeutic decisions. Psychologists will be able to help patients come to terms with initial diagnoses and understand the ramifications of different treatment options.
6. Exploring new options. Anti-TNF agents have been shown to be effective for reducing inflammation in Crohn's disease and ulcerative colitis patients, but patients have also been observed to lose response to the medication. There are an increasing number of biologic agents for IBD treatment gaining market approval. "The next stage will be to identify which patients will respond to which medications," says Dr. Denmark. "The more pathways we have, the more we need to see what pathway will serve which patient." IBD affects different areas of the body. The disease varies widely. New medications open the door to alternatives and the possibility of sparing IBD patients steroid treatment.
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