Appropriate treatment for Crohn's disease: methodology and summary results of a multidisciplinary international expert panel approach--EPACT.

Détails

ID Serval
serval:BIB_18E8A5667B09
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Appropriate treatment for Crohn's disease: methodology and summary results of a multidisciplinary international expert panel approach--EPACT.
Périodique
Digestion
Auteur⸱e⸱s
Vader J.P., Froehlich F., Juillerat P., Burnand B., Felley C., Gonvers J.J., Mottet C., Pittet V., Dubois R.W., Wietlisbach V., Michetti P.
ISSN
0012-2823
Statut éditorial
Publié
Date de publication
2006
Peer-reviewed
Oui
Volume
73
Numéro
4
Pages
237-48
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't - Publication Status: ppublish
Résumé
BACKGROUND/AIMS: For many therapeutic decisions in Crohn's disease (CD), high-grade evidence is lacking. To assist clinical decision-making, explicit panel-based appropriateness criteria were developed by an international, multidisciplinary expert panel. METHODS: 10 gastroenterologists, 3 surgeons and 2 general practitioners from 12 European countries assessed the appropriateness of therapy for CD using the RAND Appropriateness Method. Their assessment was based on the study of a recent literature review of the subject, combined with their own expert clinical judgment. Panelists rated clinical indications and treatment options using a 9-point scale (1 = extremely inappropriate; 9 = extremely appropriate). These scenarios were then discussed in detail at the panel meeting and re-rated. Median ratings and disagreement were used to aggregate ratings into three assessment categories: appropriate (A), uncertain (U) and inappropriate (I). RESULTS: 569 specific indications were rated, dealing with 9 clinical presentations: mild/moderate luminal CD (n = 104), severe CD (n = 126), steroid-dependent CD (n = 25), steroid-refractory CD (n = 37), fistulizing CD (n = 49), fibrostenotic CD (n = 35), maintenance of medical remission of CD (n = 84), maintenance of surgical remission (n = 78), drug safety in pregnancy (n = 24) and use of infliximab (n = 7). Overall, 146 indications (26%) were judged appropriate, 129 (23%) uncertain and 294 (52%) inappropriate. Frank disagreement was low (14% overall) with the greatest disagreement (54% of scenarios) being observed for treatment of steroid-refractory disease. CONCLUSIONS: Detailed explicit appropriateness criteria for the appropriate use of therapy for CD were developed for the first time by a European expert panel. Disease location, severity and previous treatments were the main factors taken into account. User-friendly access to EPACT criteria is available via an Internet site, www.epact.ch, allowing prospective evaluation and improvement of appropriateness of current CD therapy.
Mots-clé
Crohn Disease, Endoscopy, Gastrointestinal, Female, Humans, Immunosuppressive Agents, Observer Variation, Practice Guidelines as Topic, Pregnancy, Pregnancy Complications, Quality Assurance, Health Care, Remission Induction, Severity of Illness Index
Pubmed
Web of science
Création de la notice
25/01/2008 15:58
Dernière modification de la notice
20/08/2019 12:49
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