The Presence of a Dedicated IBD Clinic Social Worker Has a Positive Impact on IBD Patients' Mental Health and Quality of Life

Introduction: Patients with Inflammatory Bowel Disease (IBD) are at increased risk of psychiatric comorbidities compared to the general population. This can lead to adverse outcomes and increased healthcare utilization. Our tertiary care IBD program includes a dedicated social worker (SW) who evaluates all clinic patients for psychosocial concerns to mitigate this effect. This study aims to evaluate the impact of having an IBD SW on psychosocial scores and disease outcomes. Methods: All 1721 patients who were seen in our IBD clinic since the introduction of an IBD SW in 7/2017 were retrospectively reviewed. Inclusion criteria are patients with an IBD diagnosis who underwent complete SW evaluation and had 1 year follow up. Patients were evaluated in the year before and after SW evaluation. The number of emergency department (ED) visits and hospitalizations were evaluated to assess healthcare utilization. PHQ-9 and SIBDQ scores were evaluated to assess the impact on mental health and quality of life. Escalation of IBD therapy and need for surgery during the study period were evaluated to assess disease severity. Results: 420 patients met inclusion criteria. Patients were average age 38±15, 54% female, 25.4% minority race, 13% tobacco users, 46% alcohol users, and 17% substance users. 70% had Crohn’s Disease, 27% had ulcerative colitis, and 3% had indeterminant colitis. 117 (28%) of these patients had a social work intervention recommended, of which (48%) were documented as implemented. Comparing patient’s healthcare utilization after to before social work assessment, they had a reduction of ED visits by -0.2±1.4 ED visits per patient ( P< 0.01). Hospitalizations increased by 0.15±1.2 per patient (P=0.01). PHQ-9 decreased by 1.7±5.5 per patient (P< 0.01). SIBDQ increased by 5.2±14.9 per patient (P< 0.01). Surgery rate increased by 9.5% (x=21.6, P< 0.01). Treatment escalation increased by 16.7% (x=25, P< 0.01). Conclusion: Implementation of a dedicated SW within our IBD specialty clinic led to a significant reduction in PHQ-9 and increase in SIBDQ scores, indicating a positive effect on mental health and quality of life. There was also a decrease in ED visits, which may reflect improved outpatient patient engagement. These improvements are despite a concomitant increase in need for hospitalization, treatment escalation, and surgery. Our study supports SW incorporation into the IBD clinic model to improve the quality of care for this complex patient population (Table 1). Table 1. - This displays the mean and standard deviation of ED visits and hospitalizations per patient in the year before and after SW intervention, the mean and standard deviation of PHQ-9 and SIBDQ scores in the year before and after SW intervention, and the percent of patients undergoing surgery or treatment escalation in the year before and after SW intervention. Mean difference was compared with a dependent t-test and percent difference was evaluated with McNemar’s test, with statistical inference included in the table Patients Evaluated Prior to SW Evaluation Post SW Evaluation Mean Difference P Value ED Visits 420 0.75±1.58 0.54±1.53 -0.21±1.4 P< 0.01 Hospitalizations 420 0.39±0.76 0.54±1.22 0.15±1.2 P=0.01 PHQ-9 324 6.8±6.3 5.4±5.5 -1.69±5.5 P< 0.01 SIBDQ 310 46.7±14.0 43.0±13.1 5.2±14.9 P< 0.01 Surgery 420 5% 14.5% 9.5% X=21.6 P< 0.01 Treatment Escalation 419 42.5% 59.2% 16.7% X=25.0 P< 0.01