Preventive health measures in inflammatory bowel disease

Table 8 Preventive health measures in inflammatory bowel disease

Morbidity	Preventive measures	Setting	Provider
Venous thromboembolism
Dehydration	Encourage adequate hydration	Out-patient	PCP1, Hospitalist1
	Intravenous fluids when indicated	In-patient	Gastroenterologist2
Prolonged immobilization	Encourage physical activity	Out-patient	PCP1
	Early ambulation during hospitalization	In-patient	Hospitalist1
Indwelling catheters	Limit use of venous catheters when possible	In-patient	Hospitalist1, Gastroenterologist2
Hyperhomocysteinemia	Detection and correction of vitamin deficiencies B6, B12, folate	Out-patient	PCP1
			Gastroenterologist2
Oral contraceptives	Advise on alternative methods of contraception	Out-patient	PCP1
Active intestinal disease	Anti-inflammatory treatment, monitoring of medication and response to therapy.	Out-patient	Gastroenterologist1
(inflammatory burden)			PCP2
Cardiovascular disease
Hypertension (Primary and secondary prevention)	Low sodium diet, smoking cessation, increased physical activity.	Out-patient	PCP1
	Anti-hypertensive medication
Coronary artery disease	Low sodium diet, smoking cessation, increased physical activity, screening for hyperlipidemia. Statins, anti-platelet drugs,	Out-patient	PCP1
(Primary and secondary prevention)			Cardiologist1, Gastroenterologist2
Stroke	Anti-platelet therapy, statins, Anti-hypertensive medications	Out-patient	PCP1, Neurologist2 Gastroenterologist2
(Primary and secondary prevention)
Smoking
	Smoking cessation advise, nicotine replacement therapy, smoking cessation counselling and support programs	Out-patient	PCP1
			Gastroenterologist2
Cancer
Skin	Advise on UV exposure	Outpatient	PCP1
	Protective clothing , high SPF sunscreen		Gastroenterologist2
	Yearly physician skin exam
Colon	Surveillance colonoscopy per IBD guidelines	Out-patient	Gastroenterologist1
			PCP2
Cervical	PAP smear	Out-patient	Gynecologist1, PCP2
Breast	Counselling on breast cancer awareness	Out-patient	PCP1
	CBE every 3 yr
	Mammography after 40 yr
Prostate	Counseling and Shared-decision making on PSA testing	Out-patient	PCP1
Nutritional deficiencies	Screen for and correct nutritional deficiencies	Out-patient	PCP1
			Gastroenterologist2
Osteoporosis	DEXA in patients with increased risk of osteoporosis (hx of steroid use 10 mg daily x > 3 mo) treatment with bisphosphonates if osteoporosis confirmed.	Out-patient	PCP1
			Gastroenterologist2
Infections
Vaccine preventable infections	Vaccination	Out-patient	PCP1
			Gastroenterologist2
Reactivation of Hepatitis B virus	Screening for HBV before initiating	Out-patient	Gastroenterologist1
	Anti-TNF therapy
Reactivation of latent Tuberculosis	Screening for latent TB before initiating	Out-patient	Gastroenterologist1
	Anti-TNF therapy
Anemia	Detection and treatment of anemia	Out-patient	PCP1
			Gastroenterologist2
Depression	Depression screening PHQ 2	Out-patient	PCP1
	if positive do PHQ 9 for diagnosis		Gastroenterologist2
	Mild depression -counselling
	Moderate to severe- counselling +medication
Sleep disturbance	Screening for sleep disturbance, Counseling on sleep hygiene	Out-patient	PCP1
			Gastroenterologist2
	Medical therapy
Medication related adverse effects	Assessing medication adverse effects and interactions	Out-patient	Gastroenterologist1
			PCP2
Medication Non-adherence	Screening for medication non-adherence	Out-patient	Gastroenterologist1
	MMAS-8 item questionnaire		PCP2
	Review frequency of medication refills
	Drug levels for anti-TNF and thiopurines

¹Primary role in preventive care;

²Secondary role in preventive care. PCP: Primary care physician; MMAS-8: 8-Morisky Medication Adherence Scale.