Understanding the effects of a multidisciplinary Gastroenterology and Hepatology Integrated Care Clinic approach in patients with chronic gastrointestinal disorders: a randomised controlled trial.

The Department of Gastroenterology and Hepatology at the Princess Alexandra Hospital has recently established an Integrated Care Clinic as a strategy to help meet the growing demands for Gastroenterology and Hepatology outpatient services, to reduce waiting times and minimise risks to patients resulting from delayed health care management. The Integrated Care Clinic provides a multi-disciplinary approach by providing outpatient services cooperatively by GPs/specialists and nurses and well as by allied health professionals including psychologists, dieticians and exercise physiologists to manage patients with highly prevalent, but chronic conditions including patients with functional gastrointestinal disorders such as irritable bowel syndrome (IBS) as well as hepatology conditions such as non-alcoholic fatty liver disease (NAFLD). This study is designed to compare the effects of standard care and the Integrated Care Clinic on the health outcomes of patients in relation to psychological, dietary and activity outcome parameters. 500 consecutive English-speaking patients diagnosed with Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH), as well as stable Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS) will be will undergo routine diagnostic work-up. Thereafter patients will be randomised to receive one of three interventions: Group One will receive the individualised integrated care model which includes standardised assessment by a Gastroenterologist or Fellow, Psychologist, Dietician and Exercise Physiologist and a Primary Care Physician (GP). Following the standardised assessment, patients in Group one will receive a multidisciplinary integrated treatment approach which will may include sessions by a Psychologist, Dietician, and Exercise Physiologist as detailed under Integrated Care Model. The number of the treatment session will be determined by the individual clinicians to meet the patients needs. After a maximum of 4 months patients with either return to standard care or discharge to their GP. Group Two will receive standard care which will include a standardised assessment and routine management by a Gastroenterologist or Hepatologist. The treatment approach will be defined during the case conference and the patients will receive in total up to ten outpatient department (OPD) consultations with specialists, psychologists or allied health staff. After these 10 consultations, the patient is either discharged to the GP or continues to receive standard care in the OPD setting if this is deemed necessary by the gastroenterologists. Group Three- Patients randomised to group three receive standard care in the OPD setting. However, relevant outcome parameters will be collected 4, 12 and 26 weeks after initiation of therapy.