Rural patients with Inflammatory Bowel Disease (IBD) – burden of disease and perceived barriers to treatment.

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IBD is a complex condition, which is often associated with high morbidity and requires close and continued collaboration between patients, specialist medical care and other holistic, multi-disciplinary facilities. Despite multiple studies documenting differences in health outcomes between rural and urban patients in a number of diseases, little published data exists regarding the level of disease burden in rural patients with IBD and how this compares with what we know about urban populations. Additionally, limited knowledge regarding patient and rural practitioner perspectives on the barriers to optimal medical care exists. This is important as a large burden of disease exists outside of the metropolitan area, where specialist gastroenterology serves are absent and consequently the majority of long-term care is carried out by rural general practitioners and surgeons. The aim of the study is to initially describe the disease burden and treatment experience of IBD, in patients living in rural areas as compared to metropolitan locations. We then aim to identify any perceived barriers to the care and management of patients with IBD in the rural setting compared with their urban counterparts from the perspective of rural practitioners, IBD nurses, surgeons and gastroenterologists. Finally we will obtain the patient perspective. The study design is predominantly based upon questionnaires aimed at identifying rural practitioners IBD experience, level of IBD knowledge and perceived barriers. Perceived barriers will also be identified from a group of interested gastroenterologists and then all results will be compared to previously studies. Patients will then be surveyed to obtain their perceptions on barriers to care. Differences in healthcare outcomes will be looked at through review of a South Australian database and a new cohort in Mt Gambier and compared to a previously collected control. This study will provide quantitative data and highlight any real differences in healthcare outcomes compared with metropolitan cohorts. It will then review knowledge of and attitude to IBD amongst several medical cohorts and finally investigate perceived barriers to care from a number of different perspectives. Through the data obtained we aim to identify common perceived barriers to optimal care, which may subsequently guide the development of multi-disciplinary interventions/strategies that could be introduced to enhance rural IBD patient care. Given the current limited published data regarding this issue, it highlights an exciting opportunity to obtain such information to determine if and how interventions may be introduced that would aid in over-coming such obstacles and optimise care of this cohort in the long term.

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