P1273 Patterns of Ulcerative Colitis Management in English Rural Primary Care: A Descriptive Epidemiological and Mixed-Methods Analysis

Abstract Background Ulcerative Colitis (UC) is a chronic relapsing inflammatory bowel disease requiring sustained, coordinated management across primary and secondary care, with fragmented care linked to poorer outcomes and delays in intervention.¹⁻² Despite this, the epidemiological characteristics and data completeness of patients labelled with UC in general practice—particularly in rural settings—remain poorly defined. Inflammatory bowel disease registers are often affected by coding inconsistency and unstructured disease-activity documentation, limiting the ability to monitor progression and target care effectively.² Variation in transition processes between community and specialist services further complicates continuity of care.³ Understanding these patterns is essential for service redesign and proactive disease management. The aim is to describe the epidemiological characteristics of patients in primary care and explore variation using mixed-methods. Methods A retrospective mixed-methods evaluation was conducted using de-identified records from 64 adults with UC in a rural English practice. Quantitative variables included demographics, treatment history, coded disease activity and referral activity. Qualitative free-text entries were subjected to keyword-assisted thematic analysis, a recognised approach in health services research to uncover patterns of unmet need, system navigation difficulties, and treatment burden.4 Descriptive statistics summarised clinical distributions and documentation quality. Results The mean age was 63.6 years (IQR 55–76) with near-equal gender distribution. Clinical heterogeneity was marked: 8% had prior stoma or pouch surgery, 1% had Crohn ‘s-like features, and 10% were categorised as worsening or poorly controlled. Over half (58%) had no recorded disease-activity code despite regular prescribing activity. Thematic analysis identified recurring references to medication adjustment, cyclical flares requiring repeated investigation, and challenges engaging with specialist teams. Mental-health or quality-of-life descriptors were sparse, consistent with evidence that psychological comorbidity remains under-recognised in UC.4 Conclusion Primary-care UC registers demonstrate substantial variation in coding accuracy, documentation of disease activity and recognition of postoperative states, mirroring national concerns about pathway fragmentation and inconsistent monitoring.¹–³ Strengthening structured coding, embedding flare-response protocols and improving the visibility of mental-health assessment could enhance safety and continuity across the primary–secondary care interface. Mixed-methods epidemiology offers a pragmatic approach for identifying quality-improvement priorities in complex chronic disease management. References: 1. Rubin GP, Hungin APS, Kelly PJ, Ling J. Inflammatory bowel disease: epidemiology and management in an English general practice population. Aliment Pharmacol Ther. 2000;14(12):1553–1559. 2. National Institute for Health and Care Excellence (NICE). Inflammatory Bowel Disease Quality Standard (QS81). London: NICE; 2015. 3. Warren LR, Clarke JM, Arora S, Barahona M, Arebi N, Darzi A. Transitions of care across hospital settings in patients with inflammatory bowel disease. World J Gastroenterol. 2019;25(17):2122–2132. 4. Bartocci B, Dal Buono A, Gabbiadini R, et al. Mental Illnesses in Inflammatory Bowel Diseases: mens sana in corpore sano. Medicina (Kaunas). 2023;59(4):682. Conflict of interest: Deaney, Carl: Non promotiononal grant from Ferring Ellis, Victoria: Non promotional grant from Ferring Deakins, Kelly: Non promotional Grant received from Ferring