{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T15:28:02Z","timestamp":1778426882160,"version":"3.51.4"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,4,14]],"date-time":"2018-04-14T00:00:00Z","timestamp":1523664000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000863","name":"Bowel Disease Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000863","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003522","name":"Crohn's and Colitis UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003522","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000297","name":"Royal College of Surgeons of England","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000297","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Crohn's anal fistula should be managed by a multidisciplinary team. There is no clearly defined \u2018patient pathway\u2019 from presentation to treatment. The aim of this study was to describe the patient route from presentation with symptomatic Crohn's anal fistula to starting anti\u2010tumour necrosis factor (anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>) therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Case note review was undertaken at three hospitals with established inflammatory bowel disease services. Patients with Crohn's anal fistula presenting between 2010 and 2015 were identified through clinical coding and local databases. Baseline demographics were captured. Patient records were interrogated to identify route of access, and clinical contacts during the patient pathway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010nine patients were included in the study, of whom 54 (68%) had an established diagnosis of Crohn's disease (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>). Median time from presentation to anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> therapy was 204 days (174 <jats:italic>vs<\/jats:italic> 365 days for existing and new diagnosis of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>, respectively; <jats:italic>P<\/jats:italic> = 0.019). The mean number of surgical outpatient attendances, operations and <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> scans per patient was 1.03, 1.71 and 1.03, respectively. Patients attended a mean of 1.49 medical clinics. Seton insertion was the most common procedure, accounting for 48.6% of all operations. Where care episodes (\u2018clinical events per 30 days\u2019) were infrequent this correlated with prolongation of the pathway (<jats:italic>r<\/jats:italic> = \u22120.87; <jats:italic>P<\/jats:italic> &lt; 0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study highlights two key challenges in the treatment pathway: (i) delays in diagnosis of underlying <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> in patients with anal fistula and (ii) the pathway to anti\u2010<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> therapy is long, suggesting issues with service design and delivery. These should be addressed to improve patient experience and outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.14102","type":"journal-article","created":{"date-parts":[[2018,3,23]],"date-time":"2018-03-23T01:23:29Z","timestamp":1521768209000},"page":"797-803","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Patients with perianal Crohn's fistulas experience delays in accessing anti\u2010<scp>TNF<\/scp> therapy due to slow recognition, diagnosis and integration of specialist services: lessons learned from three referral centres"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9971-1635","authenticated-orcid":false,"given":"M. J.","family":"Lee","sequence":"first","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Freer","sequence":"additional","affiliation":[{"name":"Addenbrookes Hospital Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Adegbola","sequence":"additional","affiliation":[{"name":"St Mark's Hospital Harrow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Elkady","sequence":"additional","affiliation":[{"name":"St Mark's Hospital Harrow UK"},{"name":"University of Alexandria Alexandria Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Parkes","sequence":"additional","affiliation":[{"name":"Addenbrookes Hospital Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Hart","sequence":"additional","affiliation":[{"name":"St Mark's Hospital Harrow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. S.","family":"Fearnhead","sequence":"additional","affiliation":[{"name":"Addenbrookes Hospital Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. J.","family":"Lobo","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. R.","family":"Brown","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,4,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2007.07.157"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjw169"},{"key":"e_1_2_10_4_1","unstructured":"James Lind Alliance.Inflammatory Bowel Disease (IBD) Research Priorities from IBD Priority\u2010Setting Partnership [Internet].2015.http:\/\/www.bsg.org.uk\/images\/stories\/docs\/research\/ibd_psp_top10_final.pdf(accessed 1 November 2017)."},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13564"},{"key":"e_1_2_10_6_1","unstructured":"NHS Digital.NHS Data Dictionary: Patient Pathway [Internet].2017.http:\/\/www.datadictionary.nhs.uk\/data_dictionary\/classes\/p\/patient_pathway_de.asp?shownav=1(accessed January 2017)."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200105000-00015"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10434-000-0484-0"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.8974"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2014.04.011"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.082909"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2002.32362"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00068-9"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904492"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-017-1647-3"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-017-1645-5"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2014.01.023"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.248"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcodi.14102","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.14102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T08:04:45Z","timestamp":1694937885000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.14102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,14]]},"references-count":17,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1111\/codi.14102"],"URL":"https:\/\/doi.org\/10.1111\/codi.14102","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,14]]},"assertion":[{"value":"2017-12-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-03-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-04-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}