- A new at-home chronic disease management strategy can help patients with irritable bowel syndrome (IBS) take care of their symptoms outside of the clinic, a boon for value-based care and other current industry initiatives, showed a recent study.
The researchers, who hailed from the University of Buffalo, New York University, and Northwestern University, employed a patient self-management strategy that helps patients identify and mitigate their IBS symptoms without clinician intervention.
The treatment uses cognitive behavioral therapy (CBT) to help patients manage and reduce their symptoms and discomfort. The CBT treatments focus on brain-gut interactions, symptom self-monitoring, triggers and consequences, worry control, muscle relaxation, and flexible problem-solving, the researchers said.
Patients can receive the CBT during 10 clinic visits or in four clinic visits with additional patient education materials and self-study.
"The treatment is based on cutting-edge research that shows that brain-gut connection is a two-way street," said lead author Jeffrey Lackner, PsyD, a professor in the Jacobs School of Medicine and Biomedical Science as the University of Buffalo. "Our research shows that patients can learn ways to recalibrate these brain-gut interactions in a way that brings them significant symptom improvement that has eluded them through medical treatments."
The researchers compared outcomes for patients receiving the CBT treatment compared to those receiving clinic-based treatment or patient education treatment. More patients receiving CBT treatment saw positive clinical outcomes (61 percent) compared to those receiving clinic-based treatment (55 percent) and patient education treatment (43 percent).
These results are promising for patients suffering from IBS who often face physical barriers to care and stigma as a barrier to care. Patient self-management is less intrusive than treatment inside of a clinic and more confidential.
Between 10 and 15 percent of adult patients currently have IBS, many of whom are female, the researchers said. But because the symptoms for IBS are hard to identify and even harder to treat, these patients often face stigma that discourages accessing care. Patients are less likely to visit a doctor if they believe the doctor will tell them that their symptoms are not real or untreatable.
"These findings will be welcomed by many women and men who have unfortunately been stigmatized, marginalized and too often treated as 'head cases' merely because no definitive cause for their symptoms is identified through routine medical testing,” Lackner said.
James Jaccard, PhD, another key study contributor, agreed with Lackner.
"The creative development of this symptom-management approach for IBS can affect millions of people, primarily women, who suffer from this often stigmatized and poorly understood condition,” said Jaccard, who is also a professor at NYU’s Silver School of Social Work. “By integrating perspectives from medicine and the social sciences, it illustrates the power of team-oriented and multidisciplinary approaches to reducing health care disparities in vulnerable populations."
Although the primary demographic affected by IBS are women, these research results are also important for men, who Lackner said are also unlikely to access care due to stigma.
At-home therapies can also benefit patients living in rural areas who have difficulty accessing treatment for their IBS.
Additionally, home-based self-management treatments are essential for cutting healthcare costs, which have ballooned to about $28 billion annually for IBS patients.
The researchers maintained that their results hold water because both patients and providers observed the same positive clinical outcomes. This double confirmation highlighted the CBT treatment’s ability to help patients with their own chronic disease management, Lackner noted.
"One measure of the strength of clinical-trial findings is when two data sources report similar data about an endpoint," he explained. "In our study, there was striking similarity between the treatment response reported by patients and 'blind' assessors. This pattern of agreement from patients and physicians shows that we see very real, substantial and enduring improvement in GI symptoms immediately after treatment ends and many months later."
This therapy also aligns with many providers’ quest for treatments that help the whole patient, said Emeran Mayer, MD, PhD, professor in the David Geffen School of Medicine at UCLA and executive director of the G. Oppenheimer Center for Neurobiology of Stress and Resilience.
"The success of this research shows that this should be offered to patients not as a last resort but as a safe and effective first or second-line therapy,” Mayer explained. “It's very different from the pharmaceutical model where you are searching for magic-bullet medications. With current medications, you cannot treat the whole patient. The medications can improve their bowel habits, but it's not a complete treatment for the patient with IBS."