Disparities in Access and Treatment for Rural Patients With Inflammatory Bowel Disease: A Survey of Inflammatory Bowel Disease Patients and Providers.

Abstract

Background: With the increasing complexity of inflammatory bowel disease (IBD) care, the integration of IBD specialist gastroenterologists and multidisciplinary teams (MDTs) is becoming more important. However, access to these services is not widely available. This study sought to evaluate the needs of rural and urban IBD patients and providers in the setting of complex IBD care.

Methods: Questionnaires were administered to IBD patients, advanced practice providers (APPs), and gastroenterologists throughout the United States from September through November 2023 on topics including access to care, IBD specialists, and MDTs. Statistical analyses included t-tests, chi-square tests, analysis of variance tests, and regression.

Results: The analysis included 100 rural and 100 urban patients, 20 rural and 50 urban APPs, and 35 rural and 50 urban gastroenterologists. Rural patients were more likely to be receiving no therapy for IBD and less likely to receive advanced therapies (P = .001, P < .001, respectively). Rural patients reported less use of IBD multidisciplinary care and providers identified reduced access to multidisciplinary providers for rural patients. All patients had high interest in maintaining relationships with their current IBD provider while receiving care through a consulting MDT. Providers expressed strong interest in MDTs, with rural gastroenterologists reporting greater interest than urban gastroenterologists (P = .004).

Conclusions: These results demonstrate disparities between rural and urban patients' treatments and access to specialty IBD care. Rural patients and providers are supportive of collaborating with IBD specialists and MDTs. These results can help guide the implementation of innovative IBD care models in the setting of an increasingly complex IBD landscape.