Introduction Southampton General Hospital is a busy teaching hospital providing specialist IBD services for a population of 650,000. Biologics have impacted hugely on the management of IBD but are high cost drugs requiring careful supervision. The absence of a clear biologics pathway made it challenging to provide the support required so we developed a specialist nurse-led biologics service to improve our IBD service.
Method In 2010, an audit of biological therapies in 85 patients highlighted areas for improvement in monitoring and follow-up. A business case was developed to establish a nurse specialist to identify patients on biologics and ensure all received appropriate screening, education, and review. A 50/50 gain share was agreed with Southampton City and West Hampshire Primary Care Trust for 2013/14 onwards. The trust invested £60,000 to deliver service improvements. Outcomes were re-audited in 2014.
Results In 2010, 17% of patients had a clear management plan documented. An infection screen was documented in 79% and chest x-ray in 56% of patients. 80% were reviewed ≤12 weeks post-induction to assess primary response, 1/3 were reviewed in clinic in ≤6 months, with 20% seen less than once a year. Treatment continuation decisions were documented in 73%.
Biologic use has grown rapidly from 90 patients in 2011, to 328 in 2013. All prescription records are now kept in a centralised database. In the 2014 audit, infection screening and chest x-ray were documented in 100% of patients. 96% of patients had follow up ≤4 months post-induction to assess primary response, but 2 patients were seen 7 months post-induction. 80% were followed up again at 9–12 months (100% at 9–14 months) to assess appropriateness of treatment continuation, all with documentation of decision regarding ongoing treatment.
The service has proved cost-effective: 109 biologics were discontinued from 2012–2014 and the £60,000 investment was recouped by March 2014 through 350 outpatient appointments and 35 colonoscopies. Research recruitment resulted in 77 patients participating in biologics trials since 2012, providing further income to the trust.
Conclusion The specialist IBD biologics nurse-led service has resulted in significant gains in care quality and cost savings, fulfilling the IBD standards1by delivering high quality clinical care and a patient-centred service. The need for improved follow up of patients on biologics reflects increased pressures on clinic resources across the country. The introduction of a biologics nurse has provided invaluable support to our patients and facilitated the development of the IBD team at Southampton General Hospital.
Disclosure of interest None Declared.
The IBD Standards Group, 2009 http://www.bsg.org.uk/attachments/160_IBDstandards.pdf. – Accessed 10th September 2014