Use of community resources before inflammatory bowel disease surgery: DISCUSSION

3 Jan

This study suggests that using community supports contrib­utes to a better subjective outcome of surgery for IBD. Use of supportive resources was correlated with a higher quality of life in our sample, which is consistent with the reported value of social support for medical outcomes in general. Furthermore, the survey data suggest that in a metropolitan area with a broad range of disease-specific resources avail­able, patients with IBD report good overall resource aware­ness and a high rate of participation, approximately 75%. This is substantially higher than the previously reported rate of 20%, which may indicate relatively greater accessibil­ity of community agencies or higher motivation among IBD patients in our sample. The results of our study suggest a high motivation among subjects. It is important to note that the study, which targeted every patient receiving surgery for IBD during the study period, received a response rate of 68%. This suggests that this sample is likely to be typical of pa­tients at our centre.

Different types of community resources were associated with different outcomes in our sample. Participation in pro­fessionally trained and facilitated resources was associated with a better postoperative quality of life than was nonparticipation, whereas this difference was not significant for participants in educational and social resources. Participa­tion in professional resources is distinguished from no par­ticipation in professional resources by improved postopera­tive IBD emotional and systemic symptoms. These results suggest that trained personnel providing individualized serv­ices to IBD patients contribute positively to postsurgical quality of life; the contribution of less intensive services was not detected with our outcome measure and sample size.

The retrospective design of this study requires a caveat to this conclusion. Participation in community agencies may require a degree of illness stability such that people with more severe symptoms may not be physically able to partici­pate. The results suggest that (postsurgical) disease activity was highest in subjects who were (presurgical) nonparticipa- tors, which may support disease activity as the primary deter­minant of both resource participation and quality of life outcome. We argue against this interpretation because the most frequently used resources in the ‘professional’ group (home visits by community nurses and lay visitors) appear to require less active effort for participation than the resources in the social/educational group (ie, in general people need to feel better to go out to an educational night or a fundraising event than to be visited by a nurse). If disease activity were the primary determinant of participation, we would expect to find the lowest level of disease activity in the users of so­cial educational groups, which the data do not support. Clearly, further prospective research is required to investi­gate the interaction of presurgical disease activity, presurgical resource use and postsurgical quality of life. Failure to consider postoperative complications as a determinant of postoperative quality of life was another limitation of our study.
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This study supports the role of community service groups in the health care system, particularly resources provided by trained personnel. As a result, greater ties between service groups and health care professionals are suggested. Working together to design programs and train program leaders may improve the overall health of patients with IBD.