HJNO Sep/Oct 2024

CHANGING THE CARE: IBD 30 SEP / OCT 2024 I  HEALTHCARE JOURNAL OF NEW ORLEANS   Traditionally, IBD is treated by a gastroenter- ologist, a specialty burdened with an increas- ing number of patients and a steady and soon- to-be decreasing number of providers, making patient-facing time a valuable resource. Each patient with a diagnosis of IBD has their own unique disease phenotype, which is often ac- companied by extra-intestinal manifestations and a psychosocial impact often manifesting as anxiety and depression. Understanding the complex and sometimes irreversible nature of this disease necessitates a multimodal ap- proach keying not only on endoscopic, but also nutritional and psychological remission targeting and maintaining a definite improve- ment in quality of life. We meet each patient with an approach for shared decision making, aligning patient and provider goals. Unbun- dling specialty care within gastroenterology, and in this case IBD, allows focus and resources when and where it is needed. We recognize that it takes a multimodal approach, along with constant evaluation and realignment of goals. In addition to the traditional gastroen- terologist, we employ the skillset of a condi- tion-focused primary care physician, a regis- tered dietician, a social worker, two registered nurse coordinators, and two advanced prac- tice providers (APPs), affording each patient their singular approach to a lifelong disease. Randee Kidder, NP I think it is important to recognize that treat- ing patients with IBD is very complex and in- dividualized. I have been told a time or two by my collaborating physician that “if you have seen one IBD patient, you have seen one IBD patient,” meaning each patient’s disease and symptoms vary significantly and require individualized treatment plans. Many patients with IBD have felt hopeless- ness at some point in their disease journey. I have encountered several patients who are initially hesitant to see an APP and would rather see a physician. When we encounter such patients, we take the time to explain how our clinic operates. We assure patients that our APPs are highly trained and work closely with our physician, who is fully in- formed about each patient’s case and their proposed plan of care. This approach helps to clarify the collaborative nature of our care model and reassures patients that they will receive high-quality, coordinated care, regard- less of whether they see an APP or a physician. Once a patient is seen by one of our APPs, this opinion is often changed because our ap- pointments are not the same as a typical ap- pointment at a gastroenterologist’s office. As an APP, my background is in nursing. I went into nursing to help others. Empathy has helped me to establish trusting relationships with patients through caring and understanding. The design of this clinic allows for extended appointment times providing a valuable opportunity to build a meaningful rapport with patients. By taking time to listen carefully and engage in thorough discussions, I am able to gather comprehensive information and develop a more individualized and tailored plan of care. This includes not only addressing their gastrointestinal symptoms, but also exploring related symptoms such as anxiety, depression, and stress, as well as how these factors impact their daily functioning. I gain a comprehensive understanding of what is most important to each patient and their over- all quality of life. Using an integrated approach helps to ensure that all aspects of the patient’s health are being addressed, leading to better outcomes and a more personalized experi- ence. Additionally, providing education about their disease and the rationale behind specific recommendations helps improve adherence to treatment plans. This informed approach em- powers patients to actively participate in their care and enhances their overall well-being. It is difficult to paint a picture of a patient’s experience. There are so many intricacies that go into each patient’s treatment, but I can re- call one patient who was so ill when she first came to see us that she was in a wheelchair. She had recently been hospitalized where she was diagnosed with Crohn’s disease. She was scared and did not know what to expect with this new diagnosis that is chronic and without a cure. We were able to work with her and get her on the right medication to get her in- flammation into remission. This was the easy part. She was elated that she was feeling bet- ter. Then came the hard part — restoring her overall quality of life. She has significant joint pain that limits her physical activity, and she is obese, which increases pressure on her joints, leading to more joint pain. She deals with negative self-image and has an unhealthy re- lationship with food. Traditional recommenda- tions of diet and exercise would only set her up for failure. Ensuring we are addressing her mental health is imperative if we are going to make any progress in changing her relationship with food and food choices. Within a few weeks of starting treatment with us, she was able to ambulate without any assistive devices. And although she continues to struggle, we have helped her to make steps in the right direc- tion. She has been able to set some boundar- ies, which has allowed her to do more things for her own happiness rather than always try- ing to please others. Shifting the focus of her goals to making herself better and happier — as opposed to trying to live up to others’ expectations — has helped her to continue to meet her short-term goals with fewer setbacks. What we have offered her, that traditional care could not, is hope and the vision of a better future for herself. This patient is a great ex- ample of needing a multidisciplinary approach. Courtney Robert, LCSW, MHA The Crohn’s and Colitis Center care model emphasizes a holistic approach, including an understanding of the importance of screening for and discussion of behavioral health needs with patients. Inflammatory bowel disease has far-reaching impacts on an individual’s lived experience, including coping with the initial diagnosis, managing active symptoms, under- standing and deciding on treatment options, and navigating dietary choices as well as the stress that can come with remission due to the worry about relapse. Providing patients with an integrated care approach allows them the opportunity to develop a deeper understand- ing of the disease, a road map to navigate the extraintestinal manifestations of the dis- ease, and the ability to become more actively engaged in their own disease management. Gastrointestinal (GI) psychology is a niche but growing field that includes psychologists and therapists who have committed a special focus toward gastrointestinal disorders and un- derstanding the relationship between the brain and the gut. Researchers in the GI psychology arena have emphasized therapeutic approach- es, including cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and gut-directed hypnotherapy, in addi- tion to a growing focus placed on coping with the traumatic experiences that can come along