Healthcare Resource Utilisation, Common Mental Health Problems, and Infections in People With Inflammatory Bowel Disease

Study Overview
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Brief Summary
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Ulcerative colitis and Crohn's disease are the commonest types of inflammatory bowel disease (IBD). Both conditions range in severity from no symptoms to being potentially fatal. Both conditions are treated with medications which suppress the immune system. It is not known whether this increases the risk for infections and cancers in these conditions. It is also recognised by healthcare professionals that these conditions cause a considerable amount of psychological distress. However, this has never been measured in a large population sample. This study will investigate any associations with treatment and new onset infections and cancer. They will also examine the relationship between IBD and common mental health problems (specifically, depression and anxiety) and the impact that these have on the healthcare use (including number of general practitioner [GP] appointments, hospital attendances, and medication prescriptions. Combined, these studies should provide a better understanding of the impact of IBD on affected people and provide evidence to support the correct allocation of healthcare resources.

Detailed Description
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Objective We aim to provide an accurate and contemporary measurement of the current healthcare resource utilisation in people with inflammatory bowel disease (IBD); namely ulcerative colitis (UC) and Crohn's disease (CD). We also aim to provide estimates of infection incidence in this population and the prevalence of common mental health conditions. Method We will identify UC and CD using algorithms validated for accurately identifying these conditions from primary care records in the United Kingdom (UK). We will identify a prevalent cohort of adults with IBD with the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network over the last decade. We will identify a matched cohort of people without IBD; matched on age, gender and primary care practice. Across these cohorts we will compare healthcare resource utilisation (primary care attendances, number of primary care prescriptions for antidepressant and anxiolytic medications, number of primary care prescriptions for medications used in IBD, recorded secondary care attendances, and issue of statements of fitness for work), incident infections (any common infection, any viral infection, or any gastrointestinal infection), and common mental health conditions (depression and anxiety).

Official Title
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Healthcare Resource Utilisation, Common Mental Health Problems, and Infections in People With Inflammatory Bowel Disease (IBD)

Conditions
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Inflammatory Bowel Diseases, Ulcerative Colitis, Crohn Disease

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged ≥18 years over the study period Registered with a contributing primary care practice for any duration during the study period Exclusion Criteria: IBD not classifiable or of a type other than UC or Crohn's disease

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| People with inflammatory bowel disease<br>Adults (18+) with inflammatory bowel disease registered with a contributing GP practice during the study period | Other: No intervention<br>* Observation of routine clinical practice<br>|
| Controls<br>Adults (18+) without inflammatory bowel disease registered with a contributing GP practice during the study period | Other: No intervention<br>* Observation of routine clinical practice<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of Anxiety Episodes (Crohn's Disease) | Compare the prevalence of anxiety episodes in people with and without Crohn's disease. Number of people with at least one anxiety episode in people. | Measured over five years - 2014 to 2018 inclusive | 
| Prevalence of Anxiety Episodes (Ulcerative Colitis) | Compare the prevalence of anxiety episodes in people with and without Ulcerative Colitis. Number of people with at least one anxiety episode | Measured over five years - 2014 to 2018 inclusive | 
| Prevalence of Depressive Episodes (Crohn's Disease) | Compare the prevalence of depressive episodes in people with and without Crohn's disease. Number of people with at least one depressive episode | Measured over five years - 2014 to 2018 inclusive | 
| Prevalence of Depressive Episodes (Ulcerative Colitis) | Compare the prevalence of depressive episodes in people with and without Ulcerative Colitis. Number of people with at least one depressive episode. | Measured over five years - 2014 to 2018 inclusive | 
| Number of People With Depressive Disorder in People With and Without Crohn's Disease | Compare the prevalence of depressive disorder in people with and without Crohn's disease. | Measured over five years - 2014 to 2018 inclusive | 
| Number of People With Depressive Disorder in People With and Without Ulcerative Colitis | Compare the prevalence of depressive disorder in people with and without Ulcerative Colitis. | Measured over five years - 2014 to 2018 inclusive | 
| Number of People With at Least One Infection Event in Those With and Without Ulcerative Colitis | Number of people with at least one infection event during follow up for any common infection, gastrointestinal infection, and any viral infection. | Measured over 5 years - 2014 to 2018 inclusive | 
| Number of People With at Least One Infection Event in Those With and Without Crohn's Disease | Number of people with at least one infection event during follow up for any common infection, gastrointestinal infection, and any viral infection. | Measured over 5 years - 2014 to 2019 inclusive | 
| Number of People With at Least One Sub-infection Event in Those With and Without Ulcerative Colitis | Sub-infection outcomes: Upper respiratory tract infection (URTI), Pneumonia, Acute Bronchitis, Influenza, Skin infection, Genital infection, urinary tract infection (UTI), GI infection subset (only stool culture confirmed Clostridium difficile, Salmonella, Shigella, and Campylobacter infections), Herpes Simplex infection, Herpes Zoster infection | Measured over 5 years - 2014 to 2019 inclusive | 
| Number of People With at Least One Sub-infection Event in Those With and Without Crohn's Disease | Sub-infection outcomes: URTI, Pneumonia, Acute Bronchitis, Influenza, Skin infection, Genital infection, UTI, GI infection subset (only stool culture confirmed Clostridium difficile, Salmonella, Shigella, and Campylobacter infections), Herpes Simplex infection, Herpes Zoster infection | Measured over 5 years - 2014 to 2019 inclusive | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healthcare Resource Utilization - Primary Care Visits | Compare healthcare resource utilization in people with and without IBD, and stratifying by IBD type and compare healthcare resource utilization in people with IBD, with and without mental health illness. | Measured over five years - 2014 to 2018 inclusive | 
| Healthcare Resource Utilization - Secondary Care Emergency Attendances | Compare healthcare resource utilization in people with and without IBD, and stratifying by IBD type and compare healthcare resource utilization in people with IBD, with and without mental health illness. | Measured over five years - 2014 to 2018 inclusive | 
| Healthcare Resource Utilization - Fitness for Work Notes | Compare healthcare resource utilization in people with and without IBD, and stratifying by IBD type and compare healthcare resource utilization in people with IBD, with and without mental health illness. | Measured over five years - 2014 to 2018 inclusive | 
| Healthcare Resource Utilization: Medications for Mental Health Conditions - Selective Serotonin Reuptake Inhibitors (SSRIs) | Compare healthcare resource utilization in people with and without IBD, and stratifying by IBD type and compare healthcare resource utilization in people with IBD, with and without mental health illness. | Measured over five years - 2014 to 2018 inclusive | 
| Healthcare Resource Utilization: Medications for Mental Health Conditions - Anxiolytic Medications | Compare healthcare resource utilization in people with and without IBD, and stratifying by IBD type and compare healthcare resource utilization in people with IBD, with and without mental health illness. | Measured over five years - 2014 to 2018 inclusive |