Access to Specialists and Emergency Department Visits in Inflammatory Bowel Disease: A Population-Based Study.

Background and Aims: The number of inflammatory bowel disease (IBD) related visits to the emergency department (ED) is increasing in North America. Our study evaluates the relationship between access to specialists and utilization of ED services.

Methods: We conducted a population-based study of all IBD patients in the Ontario in 2014-2015 to measure utilization of non-emergent IBD care by specialists (NICS) and ED visits. After characterizing regional variation in access to gastroenterologists and region-wide implementation of NICS, we constructed regression models to determine whether they were predictors of individual utilization of NICS and ED services.

Results: The number of gastroenterologists per 1000 IBD patients varied geographically, ranging from 1.13 to 10.65 as did the region-wide proportion of patients who received NICS, ranging from 21% to 52%. Compared with those with low access to gastroenterologists, those living in areas with moderate (odds ratio [OR], 2.37; 95% CI: 2.27 - 2.47) and high (OR, 1.83; 95% CI: 1.71 - 1.95) access were more likely to receive NICS. The risk of visits to the ED were lower among those residing in regions with moderate (OR, 0.78; 95% CI: 0.75 - 0.82) and high access (OR, 0.74; 95% CI: 0.69 - 0.80) to gastroenterologists and in regions where implementation of NICS was not low (OR, 0.78; 95% CI: 0.75 - 0.81).

Conclusions: Poor access to outpatient IBD specialist care contributes to IBD-related ED visits. Strategies to increase specialist access may reduce the utilization of emergency services.