Abstract

Integrated Psychological Care Reduces Healthcare Costs at a Hospital-Based Inflammatory Bowel Disease Service

Lores T1, Goess C2, Mikocka-Walus A3, Collins KL4, Burke ALJ4, Chur-Hansen A5, Delfabbro P5, Andrews JM6. Clin Gastroenterol Hepatol. 2020 Jan 30. pii: S1542-3565(20)30109-9. doi: 10.1016/j.cgh.2020.01.030. [Epub ahead of print]

 
     

Author information

Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria, Australia; School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: taryn.lores2@sa.gov.au.

Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.

Department of Psychology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.

School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.

Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Medicine, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.

Abstract

BACKGROUND & AIMS: Inflammatory bowel diseases (IBD) are associated with high psychosocial burden and economic cost. Integrating psychological care into routine management might lead to savings. We performed a 2-year investigation of the effects of integrated psychological care in reducing healthcare use and costs.

METHODS: We performed a prospective study of 335 adult patients treated at a hospital-based IBD service in Australia. Participants were recruited between September 2015 and August 2016 and completed screening instruments to evaluate mental health and quality of life. Data on healthcare use and costs for the previous 12 months were also collected. Patients found to be at risk for mental health issues were offered psychological intervention. Patients were followed up 12 months after screening (between September 2016 and August 2017).

RESULTS: A significantly higher proportion of subjects at risk for mental health issues had presented to an emergency department in the 12 months before screening (51/182, 28%) compared to psychologically healthy subjects (28/152, 18%; X2(1)=4.23; P=.040). Higher levels of depression and general distress (but not anxiety) were related to increased odds of hospital admission (adjusted odds ratios, 1.07 and 1.05, respectively). Among the patients who accepted psychological intervention, the number who presented to emergency departments was reduced significantly in the 12 months after screening (follow-up) compared to the 12 months before screening (P=.047), resulting in a cost saving of AU$30,140 ($20,816 USD). A cost-benefit analysis of the integrated psychological care model revealed a net saving of AU$84,905 ($58,647 USD) over a 2-year period.

CONCLUSIONS: Risk for mental health issues is associated with higher healthcare costs in people with IBD. Providing integrated psychological care to individuals at risk for mental health issues can reduce costs, particularly by decreasing visits to emergency departments. Further studies are required to determine the best care to provide to reduce costs.

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