• Alison Shmerling, MD, MPH

PCP for IBD: Why Is Having A Primary Care Provider So Important?

Maybe you have a fantastic primary care provider. Maybe you do not have one at all. Maybe you are looking for a new one. Unfortunately, studies show that patients with IBD do not get preventive care at the same rates as patients without IBD. ¹

Mental Health


Fortunately, mental health awareness is increasing, but many patients struggling with depression and anxiety do not get appropriate treatment. Patients with IBD struggle with mental concerns at higher rates than the general population, ² and patients with untreated mental health problems are more likely to have hospitalizations.³ Did you know that your PCP can diagnose depression, anxiety, and other mood disorders and prescribe treatment? In fact, two-thirds of depression treatment happens in the primary care office.⁴ Studies show that a combination of mental health counseling and medication management can be the most effective at treating depression.⁵ Aila Health is ready to provide both.


Vaccinations


IBD patients are often started on medications that suppress the immune system. This means they are at higher risk of infections, including ones that we can prevent with vaccines. Some vaccines can be dangerous when you are already taking certain medications, but non-live vaccines are safe and recommended. ⁶


So which vaccines are “non-live,” and what does that mean? Most of the time, when you get a vaccine, you are getting a piece of the virus or bacteria, not a dose of the virus or bacteria itself. Your body sees that little piece as something dangerous and then prepares to fight the actual infection if you encounter it someday. Here is a list of non-live vaccines and recommended for all patients with IBD, no matter your level of immunosuppression:

  • Annual inactivated influenza vaccine

  • Pneumococcal (pneumonia) both PCV13 and PPSV23

  • Hepatitis A

  • Hepatitis B

  • Haemophilus influenza B

  • HPV

  • TDaP

Some vaccines might not be recommended in patients already taking medications that significantly suppress the immune system. These include the Measles Mumps Rubella vaccine, the Varicella (chickenpox) vaccine, and the Zoster (shingles) vaccine. Your doctors will be able to tell you if you are immunosuppressed, so follow their recommendations about whether these medications are safe and/or recommended for you.


What is a Cocoon? The “Cocoon” strategy is the idea that if you are immunosuppressed, everyone living with you for more than 6 months of the year should also be vaccinated to protect you. Have your roommates, significant other, siblings, etc. all talk to their doctors about getting vaccinated according to the recommended schedules.


Pap Smears


If you have a cervix and are 21 years old or older, you need a pap smear. Pap smears are the screening test to identify pre-cancerous and cancerous cells on the cervix to detect and prevent cervical cancer. Immunosuppression and smoking can both increase the risk of cervical cancer. For people with typical immune systems, the recommendation is to get a pap smear every year after age 21 until age 30, and then every 5 years after that. Immunosuppressed individuals may need a pap smear every year, including many patients with IBD. ⁷⁸ Talk to your doctor about what schedule is right for you.


Did you know? The HPV Vaccine prevents the most dangerous strains of the human papilloma virus and prevents most cervical cancer! Ask your doctor if you are a candidate to receive this shot


Skin Cancers


Patients with IBD have an increased risk of skin cancers, like basal cell and squamous cell carcinoma, and even melanoma. So make sure that you are wearing sunscreen, protective clothing, and keeping a close eye on any changing spots on your skin. If you find anything, make sure you see a provider.


Osteoporosis


While all adults at risk of osteoporosis should be screened, patients with IBD are at increased risk for several reasons, including chronic inflammation and exposure to steroids. While you should talk to your provider about your specific recommendations, you can help decrease your risk by making sure you have a diet high in vitamin D and calcium, and doing weight-bearing exercises like walking, running, or playing tennis.⁹


Smoking


Most people are aware that smoking causes lung cancer. However, did you know that smoking may increase your risk of developing Crohn’s Disease, cause the disease to progress, and worsen your overall outcomes? It may even increase your risk of developing arthritis. The good news is that quitting can lower your risk back to someone who never smoked! So talk to your health team about how to quit – it’s one of the biggest things you can do for your health.


Did you know? There are medications – in addition to nicotine replacement therapy like patches or gum – that can help you decrease your cravings and stop smoking. Schedule an appointment with your PCP to discuss options.


 
  1. Farraye, Francis A, et al. “Acg Clinical Guideline: Preventive Care in Inflammatory Bowel Disease.” American Journal of Gastroenterology, vol. 112, no. 2, 2017, pp. 241–258., doi:10.1038/ajg.2016.537.

  2. Sinclair, Jennifer A., et al. “Health Maintenance in the Inflammatory Bowel Disease Patient.” Gastroenterology Clinics of North America, vol. 41, no. 2, 2012, pp. 325–337., doi:10.1016/j.gtc.2012.01.006.

  3. Gao, Xin, et al. “Symptoms of Anxiety/Depression Is Associated with More Aggressive Inflammatory Bowel Disease.” Scientific Reports, vol. 11, no. 1, 2021, doi:10.1038/s41598-021-81213-8.

  4. Xierali, I. M., et al. “Family Physicians Are Essential for Mental Health Care Delivery.” The Journal of the American Board of Family Medicine, vol. 26, no. 2, 2013, pp. 114–115., doi:10.3122/jabfm.2013.02.120219.

  5. Hollon, Steven D., et al. “Effect of Cognitive Therapy with Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder.” JAMA Psychiatry, vol. 71, no. 10, 2014, p. 1157., doi:10.1001/jamapsychiatry.2014.1054.

  6. Rubin, Lorry G., et al. “2013 Idsa Clinical Practice Guideline for Vaccination of the Immunocompromised Host.” Clinical Infectious Diseases, vol. 58, no. 3, 2013, doi:10.1093/cid/cit684.

  7. Chhaparia, Anuj, et al. “Cervical Cancer Screening in Inflammatory Bowel Disease: Who Should Be Screening?” Gastroenterology Research, vol. 13, no. 5, Oct. 2020, pp. 208–216., doi:10.14740/gr1287.

  8. Moscicki, Anna-Barbara, et al. “Guidelines for Cervical Cancer Screening in Immunosuppressed Women without Hiv Infection.” Journal of Lower Genital Tract Disease, vol. 23, no. 2, 2019, pp. 87–101., doi:10.1097/lgt.0000000000000468.

  9. Caldera, Freddy, et al. “Comparing Guideline-Based Care Quality for Inflammatory Bowel Disease and Rheumatoid Arthritis Patients within a Medical Home.” Expert Review of Gastroenterology & Hepatology, vol. 10, no. 6, 2016, pp. 759–766., doi:10.1586/17474124.2016.1169920.











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