Sa1109 A Pilot Survey of Inflammatory Bowel Disease Patients on Health Insurance Satisfaction

Sa1109 A Pilot Survey of Inflammatory Bowel Disease Patients on Health Insurance Satisfaction Amber Elder, Julajak Limsrivilai, Peter Higgins Background: Patients with inflammatory bowel disease (IBD) often have difficulty with obtaining and maintaining adequate health insurance. There is little data on customer satisfaction with health care insurance in IBD patients to help them make decisions. Inadequate support often results in gaps in maintenance of expensive medications, especially biologic therapies. This can lead to increased rates of antibody formation and loss of response to these medicines. Aims: To identify patient and insurance factors that affect overall IBD patient satisfaction with health insurance, and perform preliminary univariate analyses to identify promising covariates that affect overall satisfaction. Methods: Using a Google Forms survey and posts on Twitter, we recruited a convenience sample of self-identified IBD patients following Amber Elder (@ColitisNinja) or Peter Higgins (@ibddoctor) on Twitter. The patient and insurance factors were collected as predictors. The outcome was overall satisfaction with health insurance. Results: The sample of 48 respondents included 23 with Crohn's disease, 21 with ulcerative colitis, and 4 with indeterminate colitis. Respondents from 24 states were represented. The average age was 35.8 years, and 77% were female. Two-thirds are currently working, 16% disabled, and 12.5% not working by choice. The respondents averaged 1.8 ER visits, 1.28 hospitalizations, and 0.8 surgeries per year. The average monthly insurance payment was $329.8, the average deductible was $1772, and the average annual out of pocket spend was $3636. Forty-four percent reported that their health insurer had denied payment for IBD medications prescribed by their physicians, and 27% have experienced a gap in biologic therapy, of whom 3 developed anti-biologic antibodies. Overall satisfaction with service provided by their healthcare insurance on a 1-10 scale averaged a 7.13 (SD 2.18). For patient factors predicting overall satisfaction, only disabled status was significant, with a strong negative effect (p=0.0015), while the number of hospitalizations and high income were weakly associated with increased satisfaction, but were not statistically significant. For insurance predictors, "Denied payment for a medication in the past year", "Coverage difficulty for any IBD medications", and "Coverage difficulty for anti-TNF" had strong negative effects on overall satisfaction with p-values of <0.0001, 0.002, and 0.021, respectively. Conclusion: This pilot survey showed that both IBD patient and insurance factors were associated with overall satisfaction with health insurance. We plan to scaling this project up through a partnership with CCFA Partners to survey a panel of thousands of IBD patients to identify factors that will improve satisfaction with health care insurance in IBD patients, and help IBD patients select the health insurance that will best suit their needs.

Sa1111 Implementation of a Patient Navigation Program Designed to Increase Awareness and Colorectal Cancer Screening Rates in an Urban, Underserved Population Alicia A. Lamanna, Amanda Robinson, Michael L. Kochman, Carmen E. Guerra Colon cancer is the 3rd leading cause of cancer deaths in the U.S. Though colorectal cancer screenings (CRCS) are effective and recommended by all clinical practice guidelines, only 64.5% of adults 50-75 years are screened. CRCS is disproportionately underutilized in inner city populations. In 2011, we created a patient navigation program to address poor CRCS rates and increase access to CRCS colonoscopies for patients in the underserved areas of West, South and Southwest Philadelphia. We directed focus on issues surrounding barriers of screening rather than direct payment for the costs of screenings so we could best leverage our resources and impact the greatest number of patients. The program was designed to target patients who were either due for, never scheduled or did not keep previously scheduled CRCS colonoscopy appointments, or were referred by providers concerned they would not keep appointments or would misunderstand pre-procedure guidelines. The program strives to improve CR health by providing free education and screening navigation through a navigator who assists patients from the 1st phone call to completion of the CRCS colonoscopy. In order to implement an effective program while providing a one-on-one service with success of a cost-effective navigator reaching out to patients that are non-adherent to CRCS, we have had to identify and address the barriers. Barriers included multiple areas: not having a companion to escort and transport the patient home from the procedure, poor awareness, fear of the procedure or sedation, limited funds to purchase prep materials, inability to read or comprehend prep instructions and hardship in being contacted or scheduling appointments. The program was able to overcome these barriers by: •Offering transportation assistance in the form of public transportation tokens or private transportation service of the patient and companion •Educating patients on the procedure, what sedation entails, importance of CRC prevention and the value of early detection •Providing free colon prep materials and instructions to the patients •Developing instructions at a 7th grade reading level and including embedded pictures •Following-up with the patient before the appointment and reviewing the entire prep process •Scheduling appointments to accommodate both the patient and companion accompanying them home Conclusions: 1. Since the program's inception, data was collected for 1787 patients contacted. 646 of the contacted patients enrolled in the program and consented to navigation. To date, 418 of the enrolled patients completed the CRCS colonoscopy over 48 months. 2. Though there are challenges with implementation for patients that have been non-adherent to CRCS, we have demonstrated that this program's intensive one-on-one patient navigation service is effective. The Process of Navigation

Sa1110 Random Colonic Biopsies in Diagnosing Microscopic Colitis: Low Yield High Cost M. Syafiq Ismail, Olufemi Aoko, Grace Kavanagh, Lisa Brandon, Rachael Flood, Karl Hazel, John Ryan, Subhasish Sengupta, John Keohane Introduction: Microscopic colitis has been recognized as a cause for chronic watery diarrhoea1 and is more common in females in their fifth to sixth decade of life2-3. This condition is diagnosed by taking random colonic biopsies from a macroscopically normal colon during colonoscopy. Taking random colonic biopsies in patients with chronic diarrhoea is a quality indicator for colonoscopy according to ASGE. However, the cost of taking random colonic biopsies can reach up to £160 ($240) per patient4. As such taking indiscriminate biopsies can incur a significant cost to the health care system. Aim: This study aims to assess the pickup rate of microscopic colitis from random colonic biopsies that were taken in 2 endoscopy referral centres in the north east of Ireland (Our Lady of Lourdes Hospital (OLOLH) Drogheda and Louh County Hospital (LCH) Dundalk) over a two year period. Method: Histology results from random colonic biopsies were obtained from the pathology department in OLOLH from the period of January 2012 to December 2013. These were compared with colonoscopy results to ensure that only biopsies from a macroscopically normal colon were included in the analysis. Results: 1050 patients had random colonic biopsies performed over the 2 year period. 30 (2.9%) patients showed non-specific colitis; 11 (1.1%) patients showed microscopic colitis while the rest were normal (96%). In the patients with microscopic colitis, 3 (27.3%) had lymphocytic colitis and 8 (72.7%) had collagenous colitis. Mean age of diagnosis of microscopic colitis is 56.5 (49 to 71) years. All 11 patients were females. All patients complained of diarrhoea which led to a colonoscopy. Conclusion: The pickup rate of microscopic colitis from random colonic biopsies in this

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study is extremely low (1.1%). As per previous studies1-3 our patient group fits the demographic profile for microscopic colitis. The potential cost of doing indiscriminate biopsies in this study could have reached £160,000 ($240,000)4. Given the current economic climate it may be more financially beneficial to risk stratify our patients prior to taking random biopsies in order to diagnose microscopic colitis. 1 Munch A. et al Microscopic colitis: Current status, present and future challenges. Journal of Crohn's and Colitis. Volume 6, Issue 9, pages 932-945, October 2012 2 Larson JK et al Chronic non-bloody diarrhoea: a prospective study in Malmö, Sweden, with focus on microscopic colitis. BMC Res Notes. 2014 Apr 14;7:236 3 Gentile NM et al The epidemiology of microscopic colitis in Olmsted County from 2002 to 2010: a population-based study. Clin Gastroenterol Hepatol. 2014 May;12(5):838-42 4 Hotouras Aet al, Diagnostic yield and economic implications of endoscopic colonic biopsies in patients with chronic diarrhoea. Colorectal Dis. 2012 Aug;14(8):985-8