Abstract
Background
Inflammatory Bowel Disease (IBD) is a chronic disease affecting increasing numbers of New Zealanders. Diet therapy plays an important role in disease treatment and management. This research project was designed to evaluate dietetic services in IBD care in New Zealand (NZ).
Aims
To investigate IBD patients’ experiences of dietetic services; evaluate the capacity of the NZ gastroenterology dietitian workforce; assess gastroenterologists’ experience of NZ IBD dietetic services and investigate differences in dietitian access for patients living in rural versus urban areas.
Methods
Online surveys of patients, dietitians and gastroenterologists were conducted in early-mid 2020. Quantitative data was analysed for statistical significance by non-parametric tests with a p-value <0.05 regarded as statistically significant. Qualitative data was analysed by thematic analysis.
Results
Responses were received from 407 IBD patients, 79 dietitians and 40 gastroenterologists. Half the patients (52%) had seen a dietitian for IBD nutrition advice. Patients more likely to have seen a dietitian were/had: Crohn’s disease (p=0.001), previous IBD surgery (p<0.001), younger (p<0.001) or receiving biologic therapy (p=0.005). Younger patients were seen faster by a dietitian than older patients (p=0.0001). There was a non-significant trend towards greater numbers of patients from urban areas having seen a dietitian than patients from rural areas.
Two-thirds (66%) of patients found the dietitian advice at least moderately useful while 18% did not. Patients who saw a dietitian in a private clinic were more likely to find the advice useful (p=0.0001), as were those who had received written advice (p<0.0001). A common theme from qualitative data was the need for dietitians to have specialist knowledge of IBD.
Almost all (97%) gastroenterologists reported that their IBD patients ask about nutrition; 57% reported that there were not enough dietitians to meet patient needs. Over 50% of dietitians saw IBD patients infrequently and 39% were not confident that they are up to date with the nutritional management of IBD. Nearly 80% would require changes to their dietetic service to allow higher numbers of IBD patients to be seen. Dietitians wished to have greater links to the IBD multidisciplinary team (MDT).
Discussion
International IBD management guidelines recommend that all patients with IBD should have access to dietetic support and nutrition therapies. NZ patients clearly do not have adequate or equitable access to dietetic services; patients wish to have ongoing dietitian access to address nutrition needs that may vary over time. Dietitians acknowledge the need for additional upskilling in the nutritional management of IBD.
Conclusion
The project achieved its key aims and concluded that current IBD dietetic services in NZ are inadequate. Increased resourcing of dietetic services and stronger links to the IBD MDT will ensure that nutrition therapy is evidence-based, collaborative and implemented in a timely manner. While some dietetic services already provide care at this level, further work is needed to guarantee that access to quality and timely dietetic care is the norm for all patients with IBD in NZ.