BACKGROUND: There is no standard treatment regimen for managing Crohn’s disease (CD), as clinical course can vary from person to person. The current study aimed to provide insight into the real-world symptoms and clinical characteristics that factor into healthcare providers’ (HCPs) treatment choices for their patients with CD in the United States (US).
METHODS: This was an observational, cross-sectional study including CD-treating HCPs. Eligible HCPs were gastroenterologists (GIs), primary care physicians (PCPs), internal medicine (IM) or family medicine (FM) physicians, nurse practitioners (NPs), or physician assistants (PAs) who treated at least 10 adult patients with CD per month, worked more than 20 hours per week in direct patient care; and were able to complete the survey in English. Self-reported data, from 21 November 2022 to 6 December 2022, were collected from HCPs using a standard web-based questionnaire. Questionnaire responses were summarized through descriptive statistics and post hoc comparisons between HCP types (GIs, FM/IM/PCPs, PAs, NPs) were performed using binomial regression models without adjustment for multiple comparisons.
RESULTS: Of 459 HCPs (male: 47.9%; 30-49 years age-group: 55.1%), 254 (55.3%) were physicians, 22.7% were NPs, and 22.0% were PAs. Approximately, 50% of the HCPs described their primary medical specialty as primary care/family care, followed by 37.7% in gastroenterology, and 12.9% in IM. From a list of 13 symptoms, HCPs most frequently considered “diarrhea” (88.7%), followed by “cramping or other abdominal pain” (86.7%), “weight loss” (83.4%), “rectal bleeding” (81.5%), and “anemia” (77.3%) when deciding on a course of treatment for a patient with CD; the remaining eight symptoms had frequencies less than 70%. The percentages were similar across HCPs except a lower percentage of GIs (31.0%) selected “constipation” than the other specialties (FM/IM/PCPs: 66.9%, P<0.0001; NPs: 55.8%, P=0.0003; PAs: 54.5%, P=0.0006). When then asked to choose the three most important symptoms, HCPs rated “cramping or other abdominal pain” (56.2%), followed by “rectal bleeding” (48.1%), “diarrhea” (42.9%), “anemia” (35.7%), and “weight loss” (35.7%) as the most important when deciding on the course of treatment. The percentages were similar across HCPs except a greater proportion of GIs (58.0%) selected “diarrhea” than the other specialties (PAs: 42.6%, P=0.0274; NPs: 38.5%, P=0.0046; FM/IM/PCPs: 36.4%, P=0.0006). Rectal bleeding (87.1%), clinical remission (86.5%), abdominal pain (83.0%), histologic appearance (70.1%), stool frequency (69.3%), mucosal appearance (68.6%), and bowel urgency (66.9%) were rated as “very important” or “extremely important” by HCPs for deciding treatment choices. When compared with the other specialties, a higher percentage of GIs rated mucosal appearance (GIs: 87.9%; PAs: 66.3%, P=0.0002; NPs: 71.2%, P=0.0026; FM/IM/PCPs: 55.8%, P<0.0001), stool frequency (GIs: 84%; PAs: 66.3%, P=0.0032; NPs: 68.3%, P=0.0075; FM/IM/PCPs: 62.3%, P<0.0001), and clinical remission (GIs: 94%; PAs: 85%, P=0.0364; NPs: 85.6%, P=0.0447; FM/IM/PCPs: 83.1%, P=0.0048) as “very important” or “extremely important”.
CONCLUSION: Real-world experience and perspectives around the treatment of CD differed among HCPs. Findings suggest a need for education among some specialties, particularly FMs, IMs, and PCPs, about the clinical presentation of CD and most important symptoms to consider when deciding how to treat patients with CD.
