Letter: Multidisciplinary Approach for Inflammatory Bowel Disease to Promote Value-Based Care

Abstract

We read with great interest the article by Kochar et al. [1] reporting that antidepressant medication use was associated with a lower rate of inflammatory bowel disease (IBD)-related Emergency Room (ER) visits, but higher rates of IBD-related hospitalisations, corticosteroid use, and surgery. This has drawn much-needed attention to the topic of behavioural health care in IBD, which warrants further dialogue.

Prior research on antidepressant medications (ADM) in IBD has been mixed. While some studies reported poor outcomes in patients with IBD on ADM, others suggested that these medications may provide benefits from treating comorbid mental health conditions, pain, and sleep issues [2, 3]. The safety of ADM use has been questioned by Coates et al. [4] who also opined that the methodological design of the study prevented any causal conclusions.

An alternative interpretation of the findings of Kochar et al. is that, when patients with IBD are engaged in mental health treatment, they may display differential behaviours when utilising healthcare. Patients initiated on ADM are often more closely connected to their care teams due to the follow-up associated with these medications. The ADM prescription itself may serve as a proxy for higher disease severity for the clinical team, thereby prompting closer monitoring. This familiarity may make providers more vigilant and encourage patients to communicate their concerns early. This may lead to an increased likelihood of planned medical admissions to stabilise IBD-related concerns rather than urgent, unplanned care-seeking in emergency departments. ADM use may also stabilise emotional functioning and support effective coping, leading to proactive communication with the outpatient care team rather than relying on ER settings to reactively manage urgent issues.

While these proposed mechanisms may explain the findings of Kochar et al. the safety and outcomes of ADM on gastrointestinal symptoms remain inadequately understood; management of mental disorders in IBD often involves ad hoc clinical strategies. A consensus statement has emphasised the identification of mental health disorders and referral to treatment as an integral part of IBD care. Although anxiety and depression screening is typically considered routine for patients with IBD, the identification of subclinical mood symptoms and other IBD-specific psychosocial concerns is often overlooked [5].

In recognition of these needs, IBD care is evolving toward a holistic, patient-centred, multidisciplinary collaborative approach that also encourages value-based care [6]. Coordinated care involving gastroenterologists, GI psychologists, psychiatrists, dietitians, nurse practitioners, and social workers is encouraged to address the biological and psychosocial aspects of IBD, with the potential to reduce IBD-related ER visits and hospitalisations.

Longitudinal assessment of depressive symptom severity within multidisciplinary, holistic IBD care may help to clarify how changes in depression relate to outcomes such as health care utilisation and IBD disease activity. Furthermore, future research should prospectively examine how treating psychiatric comorbidities, either through pharmacological approaches alone or in conjunction with behavioural therapies in a collaborative care model, affects patient-centred outcomes, emergent and inpatient care utilisation, and cost effectiveness.

Manavjot Singh: conceptualisation, writing – original draft. Madhusudan Grover: writing – review and editing. Megan Petrik: conceptualisation, writing – review and editing. All authors approve of the final version of the article, including the authorship list.

The authors declare no conflicts of interest.

This article is linked to Kochar et al paper. To view this article, visit https://doi.org/10.1111/apt.70229.