P062 For Which Subsets of IBD Patients Are Integrated Behavioral Services Most Useful Within the IBD Medical Home?
Authors: Myers Cassie , Proksell Siobhan , Schwartz Marc , Szigethy Eva , Weaver Emily , Alchoufete Therezia 
Published: December 2019

BACKGROUND:
Patients with inflammatory bowel disease (IBD) have higher rates of psychiatric comorbidity which can impact adherence to treatment plans, medical response, and overall quality of life. Integrated behavioral management within an IBD-specific medical home (MH) shows promise in improving clinical outcomes. Effective behavioral interventions may differ depending on source of symptoms (active vs inactive disease). Study aims are to: 1) characterize behavioral complexity in adults with moderate to severe IBD symptoms at the time of enrollment in the IBD MH; and 2) evaluate the relationship between use of behavioral services and medical and behavioral self-reported measures over a 6-month period.

METHODS:
The sample consisted of adults with moderate to severe IBD symptoms, enrolled in the IBD MH from 2018 to 2019 with at least two office visits over a 6-month period. Clinical data from the electronic health records were included. Patient-reported depression (PHQ9), generalized anxiety disorder 7 (GAD-7), quality of life (QoL; SIBDQ), and IBD severity (HBI/UCAI) were recorded at baseline and subsequent office visits. These scores were used to calculate the IBD Biopsychosocial Complexity Grid, a tool which organizes this health information into biological, psychological, and nutritional domains and serves as the basis for algorithm-driven treatment planning within the IBD MH. Psychiatric diagnoses and patient engagement in behavioral services within the IBD MH were recorded.

RESULTS:
62 IBD patients with high baseline IBD symptoms were examined. All but one of these patients had at least one psychiatric diagnosis and 13 had ≥3 psychiatric diagnoses. All but 2 patients engaged in at least one encounter with behavioral providers within the MH. Approximately half (n = 30) of the 62 patients had active inflammation noted on colonoscopy at baseline. Of these 30 patients, 47% (n = 14) had significant improvement of their IBD inflammation, symptoms, and behavioral outcomes over the 6-month period. While 53% (n = 16) of patients with persistent active inflammation, also showed significant improvement in IBD symptoms and behavioral scores. All 30 patients engaged with behavioral providers. Another 30 patients had no active inflammation noted at their first and second visits yet reported high levels of IBD symptoms. These patients with more functional GI symptoms had more comorbid psychiatric diagnoses and even though they utilized behavioral services, showed less improvement in depression/anxiety scores compared to those with high baseline IBD inflammation. IBD patients with high baseline and continued active inflammation noted on colonoscopy all utilized behavioral health services at high rates and had improvement in PHQ9, GAD7, SIBDQ, and HBI/UCAI scores. None of the sample had a surgical intervention during the study period.

CONCLUSION(S):
IBD patients with moderate-severe reported symptoms had significant psychiatric comorbidity and utilized behavioral health providers in the IBD MH at equally high rates, regardless of symptom source (active inflammation or functional symptoms). Patients with active inflammation showed improvement in psychosocial functioning despite no disease improvement, suggesting that an integrated approach benefits patients with active disease even when disease markers do not improve. Patients with functional symptoms had more psychiatric complexity, and distress persisted despite behavioral interventions, suggesting patients with functional symptoms may benefit from different and possibly more intensive psychosocial care.