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Integrating care for young adults with inflammatory bowel disease

Tuesday 15 September 2020

Integrating care for young adults with inflammatory bowel disease
Mater’s Inflammatory Bowel Diseases team in South Brisbane are providing integrated care for young adults and adults with Crohn’s Disease and Ulcerative Colitis. These diseases cause chronic inflammation of the gut leading to significant symptoms, morbidity and high rates of disability. However, the precise cause is still not fully understood. The incidence has been increasing and Australia has among the highest in the world with 85,000 IBD patients across the nation, 17 000 of which are in Queensland.
Patients typically present in their teens and early 20’s, although a person can be diagnosed at any age. They often present with debilitating gastrointestinal symptoms but can also have other symptoms throughout the body, including mental health consequences. The Mater Hospital in South Brisbane has developed a multidisciplinary approach to care, tailoring management to the needs of the individual patient. The IBD team comprises subspecialty trained gastroenterologists, specialty nurses including an IBD CNC, colorectal surgeons, dieticians, mental health professionals and the wider allied health team. The team works collaboratively and has weekly multi-disciplinary meetings, and this has continued throughout the pandemic via video-conferencing technology. 
Although medications available through the PBS, as well as surgeries and dietary therapies play a major role in treating the majority of IBD patients, Mater patients and patients referred in from other sites have the benefit of an additional arm of care: the IBD clinical trials unit provides patients with advanced therapeutic options. In addition, many patients choose to partner with our IBD research team through contributing to one of the largest IBD Biobanks in Australia and participating in investigator-initiated research including a clinical trial of mindfulness-based cognitive therapies.
The Mater was the first IBD service in Queensland to introduce routine intestinal ultrasound to clinics which allows non-invasive testing on the day of outpatient appointment. This informs therapy and reduces the need for frequent endoscopic assessments. The Mater has also been the first service in Queensland to introduce needle-knife stricturoplasty, a new interventional endoscopic technique to help reduce the need for surgical resection and preserve the bowel.
Since the peak incidence of IBD occurs during the childbearing years, the Mater has also implemented an IBD Fertility and Maternity service. Through a grant from the Gastroenterological Society of Australia (GESA), the IBD Fertility and Maternity Service in collaboration with the Mater Mother’s Foetal Maternal Medicine team meet regularly to ensure this service is able to support patients through pregnancy. Special considerations are made with respect to the safety and dosing of medications and impact of IBD on delivery and foetal development.
The young age of patients with IBD is associated with a high burden of illness including psychological symptoms which requires a multimodal treatment approach. The Mater Young Adult Health Centre Brisbane is a unique purpose-build outpatient and inpatient facility ideally positioned to provide care for patients with a focus on young adults and adolescents with chronic illnesses. The integrated care through the Young Adult Support Unit (YASU) provides a patient-focused clinical experience suited to the unique needs of these patients. With specialty trained adolescent psychiatric expertise, psychology, occupational therapy and social work, the IBD patients have access to innovative support programs including a custom designed mindfulness intervention program and art therapy sessions.
With a cohort of over 1000 patients across the Mater public and private hospitals in South Brisbane, the Mater Hospital IBD team are providing world class care that enables people with Crohn’s disease and Ulcerative Colitis to lead normal lives. 

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