P4362 - Treat to Target Recommendations and Adherence in Inflammatory Bowel Disease: Provider Perspectives

Frank I.. Scott, MD, MSc(Epi)¹, Jason K. Hou, MD, MS, FACG², Donald Lum, MD, FACG³, Dana J. Lukin, MD⁴, Ann D. Flynn, MD, FACG⁵, Corey A.. Siegel, MD, MS⁶, Gil Y. Melmed, MD⁷, Alandra Weaver, MPH⁸, Danielle Duran, MA⁹, Sarah E. Brewer, PhD, MPA^1
1University of Colorado Anschutz Medical Campus, Aurora, CO; ²Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; ³The Oregon Clinic, Portland, OR; ⁴Jill Roberts Center for Inflammatory Bowel Disease, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY; ⁵University of Utah, Salt Lake City, UT; ⁶Dartmouth-Hitchcock Medical Center, Lebanon, NH; ⁷Cedars-Sinai Medical Center, Los Angeles, CA; ⁸Crohn's and Colitis Foundation, New York, NY; ⁹University of Colorado School of Medicine, Aurora, CO

Introduction: “Treat-to-Target” (T2T) monitoring in inflammatory bowel disease (IBD) allows for proactive treatment decisions based on scheduled biochemical marker and structural assessment. Clinical trials have demonstrated that this approach improves remission rates and decreases healthcare utilization. However, despite international promotion and guidance statements such as STRIDE, T2T adherence remains low. We sought to understand the perspectives of gastroenterologists on T2T utilization and the factors inhibiting T2T adherence.




Methods: Using a modified grounded theory methodology, we conducted individual semi-structured interviews with gastroenterology providers at 5 sites in IBD Qorus, a national quality of care collaborative supported by the Crohn’s and Colitis Foundation. Interviews were conducted by a trained qualitative research assistant, lasted ~60 minutes, and explored understanding and descriptions of T2T monitoring and treatment decision-making, communicating with and educating patients about T2T, and barriers and facilitators to T2T adherence. Interviews were recorded, transcribed, and entered into ATLAS.ti. We mined field notes and reviewed transcripts to identify emergent topics, conducted open coding, then used axial and selective coding to develop categories. Data were synthesized into core themes.




Results: Participating providers (n=16) were 32% female, represented 5 states, and averaged 13 years in practice. Analyses revealed four main themes influencing T2T adherence: 1) T2T was not fully understood by providers and many equated constructs with other STRIDE guidelines; 2) provider perceptions of the correct timing of biochemical and/or structural monitoring were not homogenous; 3) insurance and prior authorizations significantly delay or prevent treatment and 4) clinical remission is the top priority, while biochemical and structural remission are supplemental goals.




Discussion: Our findings, derived from interviews with gastroenterologists with a focus on IBD-related care, indicate opportunities to improve T2T adherence through more direct guidelines on implementing T2T monitoring in practice. Additionally, directives on mindfully incorporating T2T monitoring, incorporating patient preferences and maximizing feasibility will promote adherence. Because insurance and prior authorization can act as a barrier to treatment initiation, improved approval processes would help to decrease delays in patient care and decrease healthcare utilization.





Disclosures:


Frank I.. Scott, MD, MSc(Epi)¹, Jason K. Hou, MD, MS, FACG², Donald Lum, MD, FACG³, Dana J. Lukin, MD⁴, Ann D. Flynn, MD, FACG⁵, Corey A.. Siegel, MD, MS⁶, Gil Y. Melmed, MD⁷, Alandra Weaver, MPH⁸, Danielle Duran, MA⁹, Sarah E. Brewer, PhD, MPA¹. P4362 - Treat to Target Recommendations and Adherence in Inflammatory Bowel Disease: Provider Perspectives, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.