# Adherence to a care pathway for inflammatory bowel disease in the southwest region of the Netherlands: results of a mixed-methods implementation study

## TL;DR

This study evaluated how well hospitals in the southwest Netherlands followed a care pathway for inflammatory bowel disease and found mixed results with some improvements and challenges in implementation.

## Contribution

The study provides insights into the implementation of a care pathway for IBD using mixed methods, highlighting barriers and facilitators in a real-world setting.

## Key findings

- Adherence to ordering blood tests and documenting side effects and medication adherence improved significantly.
- Documentation of infectious disease screening decreased over time, while smoking status and flare assessment improved.
- Barriers included difficulty changing routines and the complexity of implementing the pathway in health records.

## Abstract

In southwest Netherlands, hospitals collaborate to provide high-quality care for inflammatory bowel disease (IBD). To achieve this, a care pathway (CP) was implemented for treating IBD with advanced therapies. This study assessed the adherence to the CP and identified implementation barriers and facilitators.

A mixed-methods study was conducted. Quantitative data collected from health records from December 2020 to March 2023 were used to evaluate adherence, and differences were analysed with generalised mixed models. Surveys and semistructured interviews with healthcare providers (HCPs) were used to identify barriers and facilitators, using the extended normalisation theory.

The study included 299 patients. Documentation of repeated screening for infectious diseases when prior tests exceeded 1 year decreased (p<0.001). Adherence to ordering blood tests as advised increased (p<0.001). For patients experiencing a flare, a small but significant increase was observed in the use of validated questionnaires for scoring disease activity (p=0.004). Adherence improved in registering smoking status (p=0.003), side effects (p<0.001), medication adherence (p<0.001) and ordering advised blood tests as recommended (p<0.001). Weight registration decreased (p=0.002).

From 85 surveys, 42 were completed, with 11 interviews conducted. Facilitators were improving collaboration and the potential to standardise care. Barriers were the complexity of the implementation in health records, the difficulty for providers to change routines and IBD heterogeneity.

Adherence to the CP appears to be challenging, due to the difficulty HCPs experience in changing routines. Discrepancies between performed and documented tasks may affect adherence rates. The gradual improvement suggests increased familiarity with the CP may enhance adoption.

MEC-2020-075.