Abstract
The aim of the study. There was a study of indicators of the quality of care provided in a comparative aspect at the primary level, as well as at the specialized level of the tertiary center. Materials and methods . Retrospective analysis of outpatients and inpatients with IBD followed at a tertiary center. Analyzed quality indicators: time to start therapy at the onset of the disease; proper use of steroids; monitoring the safety of immunobiological therapy and others. Results and discussion. The prevailing majority of patients were observed in general gastroenterologists (75.2% with Crohn's disease and 53.6% with ulcerative colitis, respectively, p<0.021, than in gastroenterologists specializing in IBD (24.8% and 46.4%, respectively, p><0.021). Patients with Crohn's disease were significantly more often diagnosed after the first emergency hospitalization (59.4%, p<0,012) first-time inpatient therapy was prescribed (58.8%, p<0,002), surgical intervention was more often required (36.2% p<0,002), as well as more than 2 courses of steroids (27.9%, p<0,030). Before the appointment of immunosuppressive therapy, tuberculosis screening is carried out in 68.6% of cases of IBD, testing for viral hepatitis - 83.5% of cases; Cl. Difficile and CMV, if indicated, were excluded only in a third of patients with IBD (28.2%, p<0,046 and 38,3%, p<0,024 respectively). IBD specialists are more likely to be referred for primary endoscopic examination (82.3%) in comparison with PHC specialists (52.4%, p<0,01). Regular (endoscopic) screening for dysplasia, taking into account risk factors, was performed only in 41.2% in CD and 30.8% in UC; the recommendation was given in 62.9% of cases by IBD specialists and 20.6% of cases by primary care physicians Conclusions. Given the complex nature of the pathology, the lifelong disabling course, it is necessary to expand access to specialized care, raise awareness of primary care specialists about early diagnosis measures, pathogenetic therapy aimed at preventing complications.