Factors associated with urgent consultation recommendations for patients with inflammatory bowel disease calling a telephone service about worsening symptoms: a secondary analysis.

BACKGROUND: The study aim was to clarify the physical condition of patients with inflammatory bowel disease (IBD), to clarify healthcare providers’ recommendations to IBD patients calling a telephone service about worsening symptoms, and to analyze the factors associated with a recommendation for an urgent hospital visit. METHODS: We conducted a secondary analysis of prospectively documented telephone consultation sheets and medical records at a single urban IBD clinic in 2019. Information on patients’ physical condition at the time of the consultation, patients’ needs, and healthcare provider instructions was extracted and summarized using content analysis (inter‑rater κ coefficient = 0.69–0.95). Logistic regression analysis was used to examine the factors associated with the recommendation for urgent consultation for patients with Crohn’s disease (CD). RESULTS: Of 170 telephone consultations, 105 (61.8%) were for CD, and 95 (55.9%) patients were advised to seek urgent consultation. Eighteen symptom categories were identified; the average symptom count was 2.9. For CD, history of bowel resection (odds ratio [OR] 3.99, 95% confidence interval [CI] 1.36–10.7) and higher symptom count (per‑symptom OR 1.78, 95% CI 1.16–2.75) independently predicted urgent recommendation (area under the curve=0.757 [0.68–0.83]). CONCLUSION: Real‑world telephone triage for IBD frequently results in urgent consultation recommendations. Two readily assessable features—symptom count and surgical history—can help to identify patients needing urgent evaluation, thus informing practical triage in nurse‑led advice lines. It is important to establish a system that can make appropriate decisions about urgent consultations for patients with IBD.