Introduction The follow-up of IBD patients is challenging due to the relapsing remitting nature of the diseases, the wide spectrum of severity and complexity as well as the need for monitoring of long-term complications and drugs. Conventional outpatient follow-up lacks flexibility for patients and there are competing pressures for clinic time such as 18-week targets, follow-up appointment waiting times, new patient to follow-up ratios and increasing demand. Alternatives to conventional outpatient follow-up include telephone clinics, self-management programmes or discharging patients. The IBD Virtual Clinic (VC) is an effective alternative model. Patients with an established diagnosis for >2 years, who have been stable for >1 year, do not have PSC and are agreeable are entered into the VC system. Two months before their annual follow-up is due a blood test form, simple questionnaire and information sheet are sent to the patient. If they meet any of the criteria on the questionnaire they are asked to contact the IBD specialist nursing team to discuss their condition. The blood test results, patient's database entry and case notes are reviewed to ensure that they are not due colonoscopic surveillance, DEXA scanning etc. The patient and their GP are sent a letter informing them of the blood test results and management plan.
Methods The VC database was reviewed to assess the effectiveness of the service. 127 patients were asked to complete an on-line or postal satisfaction survey on their VC experience.
Results Between 2006 and 2009 306 patients with UC and 177 with CD have been added to the VC. In the period 2006–2008 79 patients required an out-patient appointment for a flare, 9 were admitted, 7 had abnormal blood tests and 12 DNAed follow-up. An estimated 866 outpatient appointments have been saved. 66% of patients responded to the survey. 9.1% of patients preferred conventional outpatient follow-up while 87.6% felt their condition was adequately monitored using the VC. 88.9% of employed patients felt that due to the VC their condition interfered less with their work while 71.8% of all patients felt their condition interfered less with their family/social life. 26.6% of patients found it difficult to get bloods tested at their GPs. 92% and 86.6% of patients who contacted the flare line and non-urgent advice line, respectively were satisfied with the service. Flare patients were seen within a mean of 5.3 days and 92% of non-urgent messages responded to within 2 days.
Conclusion This is an innovative, efficient, patient responsive method for following up patients with stable IBD. Benefits include a reduction in new:follow-up clinic ratios, increased outpatient capacity to see flare patients and a reduction in secondary care visits for patients. In addition it meets the IBD Standards for follow-up of patients. The model has now been applied to coeliac disease and Barrett's oesophagus.
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