Title: Healthcare service use in paediatric inflammatory bowel disease: a questionnaire on
patient and parent care experiences in Germany
Version: 1 Date: 27 Sep 2023
Reviewer's report:
The authors identified the current state of health care services in the care of pediatric IBD in
Germany through a questionnaire to patients and their parents. I read the article with great
interest. As shown in Figure 2, I was impressed at the German healthcare system, which provides
access to a pediatric gastroenterologist within 60 minutes in most areas of the country. On the
other hand, as stated by the authors, the main limitation of this study is the selection bias of
the participants. However, I can make sense that any further investigation is realistically very
difficult. Here are some points that the authors should make more clear for publication.
Please refer to the comments below:
Major points
#For logistic regression models, TABLEs should be described to clarify the presentation and
combination of specific explanatory variables. It will be more reader friendly.
#The following three points that did not reach statistical significance should be deleted from the
text. I think the hypothesis is not sufficient, and removing them from the text of the RESULT
would have little impact on the discussion or the message to the reader.
1.patients with UC were less likely (OR 0.9; 95% CI 0.41-2.00) to seek nutritional counselling
compared to patients with unclassified IBD.
2.those with a diagnosis of 3-4 years were more likely (OR 1.33; 95% CI 0.69-2.57) to seek
psychological services than patients with a diagnosis of more than 6 years ago.
3.those who were diagnosed 5-6 years ago were less likely to not use services (OR 0.63; 95%
CI 0.30-1.37). These only make the resulting text redundant. As mentioned above, a table can
be created to inform the reader.
#I wonder if the questions about nutritional counselling, psychological counselling, and
physiotherapy were closed questions or open questions? Hopefully this will be clearly stated in
the method in the text. Were there any other choices or answers in the questionnaire? If there
were any other choices or answers in the questionnaire, even a few, the reader would want to
know.
#I wonder if the “comorbidity” question was also a closed question or an open question? It should
be added to the method statement. I am concerned that bias may occur due to the perception of
the participants. If this is an open question, what is the definition of comorbidity that participants
were told, especially about psychological disorders? Is it based on the participant's subjective
judgment or an objective diagnosis from a physician?
#I wonder about the inclusion of psychological disorder in comorbidity. I think that patients
with psychological disorder are very likely to have received psychological counselling. If
psychological disorder is excluded from comorbidity, would the results change? Would this
explain the gap in results between patients and parents?
#The authors mentioned the lack of comparisons between regions as one of limitations.
However, I guess that geographic differences are what the reader wants to know and may be
the main objective of this study. For example, could authors show the difference in these results
between Lower Saxony (more pediatric IBD patients and fewer pediatric gastroenterologists)
and Northrhine-Westphalia (which had more pediatric IBD patients and more pediatric
gastroenterologists)? Or could authors compare between the area that was the pinkest (High-
Low) and the bluest (Both High) in Figure 2? Also, the authors state that “with the coverage
of health insurance, 16.3% of the parents were dissatisfied and 8.51% stated that they had been
refused treatment in the past”. Regarding this, it would be better to consider regional differences
as well. This is just a suggestion.
#In the conclusion, the authors stated that “mental health services should be strengthened”. This
study has identified the rate of patients receiving mental health services, but has not been able to
show that there is a shortage. The authors can mention the importance of mental health screening
in the discussion part. However, this is an inappropriate conclusion to this study. As mentioned
above, if there is a difference in the rate of patients receiving mental health services between
regions, the authors may conclude that screening mental health services should be strengthened.
Please reconsider…
Minor
#Line 35, PPIBD # PIBD
Title: Healthcare service use in paediatric inflammatory bowel disease: a questionnaire on
patient and parent care experiences in Germany
Version: 1 Date: 27 Sep 2023
Reviewer's report:
The authors identified the current state of health care services in the care of pediatric IBD in
Germany through a questionnaire to patients and their parents. I read the article with great
interest. As shown in Figure 2, I was impressed at the German healthcare system, which provides
access to a pediatric gastroenterologist within 60 minutes in most areas of the country. On the
other hand, as stated by the authors, the main limitation of this study is the selection bias of
the participants. However, I can make sense that any further investigation is realistically very
difficult. Here are some points that the authors should make more clear for publication.
Please refer to the comments below:
Major points
#For logistic regression models, TABLEs should be described to clarify the presentation and
combination of specific explanatory variables. It will be more reader friendly.
#The following three points that did not reach statistical significance should be deleted from the
text. I think the hypothesis is not sufficient, and removing them from the text of the RESULT
would have little impact on the discussion or the message to the reader.
1.patients with UC were less likely (OR 0.9; 95% CI 0.41-2.00) to seek nutritional counselling
compared to patients with unclassified IBD.
2.those with a diagnosis of 3-4 years were more likely (OR 1.33; 95% CI 0.69-2.57) to seek
psychological services than patients with a diagnosis of more than 6 years ago.
3.those who were diagnosed 5-6 years ago were less likely to not use services (OR 0.63; 95%
CI 0.30-1.37). These only make the resulting text redundant. As mentioned above, a table can
be created to inform the reader.
#I wonder if the questions about nutritional counselling, psychological counselling, and
physiotherapy were closed questions or open questions? Hopefully this will be clearly stated in
the method in the text. Were there any other choices or answers in the questionnaire? If there
were any other choices or answers in the questionnaire, even a few, the reader would want to
know.
#I wonder if the “comorbidity” question was also a closed question or an open question? It should
be added to the method statement. I am concerned that bias may occur due to the perception of
the participants. If this is an open question, what is the definition of comorbidity that participants
were told, especially about psychological disorders? Is it based on the participant's subjective
judgment or an objective diagnosis from a physician?
#I wonder about the inclusion of psychological disorder in comorbidity. I think that patients
with psychological disorder are very likely to have received psychological counselling. If
psychological disorder is excluded from comorbidity, would the results change? Would this
explain the gap in results between patients and parents?
#The authors mentioned the lack of comparisons between regions as one of limitations.
However, I guess that geographic differences are what the reader wants to know and may be
the main objective of this study. For example, could authors show the difference in these results
between Lower Saxony (more pediatric IBD patients and fewer pediatric gastroenterologists)
and Northrhine-Westphalia (which had more pediatric IBD patients and more pediatric
gastroenterologists)? Or could authors compare between the area that was the pinkest (High-
Low) and the bluest (Both High) in Figure 2? Also, the authors state that “with the coverage
of health insurance, 16.3% of the parents were dissatisfied and 8.51% stated that they had been
refused treatment in the past”. Regarding this, it would be better to consider regional differences
as well. This is just a suggestion.
#In the conclusion, the authors stated that “mental health services should be strengthened”. This
study has identified the rate of patients receiving mental health services, but has not been able to
show that there is a shortage. The authors can mention the importance of mental health screening
in the discussion part. However, this is an inappropriate conclusion to this study. As mentioned
above, if there is a difference in the rate of patients receiving mental health services between
regions, the authors may conclude that screening mental health services should be strengthened.
Please reconsider…
Minor
#Line 35, PPIBD # PIBD
Please review this paper.
user
Title: Healthcare service use in paediatric inflammatory bowel disease: a questionnaire on
patient and parent care experiences in Germany
Version: 1 Date: 27 Sep 2023
Reviewer's report:
The authors identified the current state of health care services in the care of pediatric IBD in
Germany through a questionnaire to patients and their parents. I read the article with great
interest. As shown in Figure 2, I was impressed at the German healthcare system, which provides
access to a pediatric gastroenterologist within 60 minutes in most areas of the country. On the
other hand, as stated by the authors, the main limitation of this study is the selection bias of
the participants. However, I can make sense that any further investigation is realistically very
difficult. Here are some points that the authors should make more clear for publication.
Please refer to the comments below:
Major points
#For logistic regression models, TABLEs should be described to clarify the presentation and
combination of specific explanatory variables. It will be more reader friendly.
#The following three points that did not reach statistical significance should be deleted from the
text. I think the hypothesis is not sufficient, and removing them from the text of the RESULT
would have little impact on the discussion or the message to the reader.
1.patients with UC were less likely (OR 0.9; 95% CI 0.41-2.00) to seek nutritional counselling
compared to patients with unclassified IBD.
2.those with a diagnosis of 3-4 years were more likely (OR 1.33; 95% CI 0.69-2.57) to seek
psychological services than patients with a diagnosis of more than 6 years ago.
3.those who were diagnosed 5-6 years ago were less likely to not use services (OR 0.63; 95%
CI 0.30-1.37). These only make the resulting text redundant. As mentioned above, a table can
be created to inform the reader.
#I wonder if the questions about nutritional counselling, psychological counselling, and
physiotherapy were closed questions or open questions? Hopefully this will be clearly stated in
the method in the text. Were there any other choices or answers in the questionnaire? If there
were any other choices or answers in the questionnaire, even a few, the reader would want to
know.
#I wonder if the “comorbidity” question was also a closed question or an open question? It should
be added to the method statement. I am concerned that bias may occur due to the perception of
the participants. If this is an open question, what is the definition of comorbidity that participants
were told, especially about psychological disorders? Is it based on the participant's subjective
judgment or an objective diagnosis from a physician?
#I wonder about the inclusion of psychological disorder in comorbidity. I think that patients
with psychological disorder are very likely to have received psychological counselling. If
psychological disorder is excluded from comorbidity, would the results change? Would this
explain the gap in results between patients and parents?
#The authors mentioned the lack of comparisons between regions as one of limitations.
However, I guess that geographic differences are what the reader wants to know and may be
the main objective of this study. For example, could authors show the difference in these results
between Lower Saxony (more pediatric IBD patients and fewer pediatric gastroenterologists)
and Northrhine-Westphalia (which had more pediatric IBD patients and more pediatric
gastroenterologists)? Or could authors compare between the area that was the pinkest (High-
Low) and the bluest (Both High) in Figure 2? Also, the authors state that “with the coverage
of health insurance, 16.3% of the parents were dissatisfied and 8.51% stated that they had been
refused treatment in the past”. Regarding this, it would be better to consider regional differences
as well. This is just a suggestion.
#In the conclusion, the authors stated that “mental health services should be strengthened”. This
study has identified the rate of patients receiving mental health services, but has not been able to
show that there is a shortage. The authors can mention the importance of mental health screening
in the discussion part. However, this is an inappropriate conclusion to this study. As mentioned
above, if there is a difference in the rate of patients receiving mental health services between
regions, the authors may conclude that screening mental health services should be strengthened.
Please reconsider…
Minor
#Line 35, PPIBD # PIBD
assistant