Introduction Self management programmes are central to any long term strategy for managing chronic disease, the emphasis being to create expert patients who have the confidence, skills, information and knowledge to play a key role in their care and minimise the impact of the disease on their lives.1In addition, this has been shown to reduce attendance in outpatients and reliance upon the health care system.2The aim of the study was to monitor outcomes of a nurse led guided self management programme.
Method A database of patients who had commenced self-management programme between January 2007 and January 2008 was created and maintained. Demographic data, diagnosis, colorectal cancer and osteoporosis surveillance, telephone helpline contacts, outpatient attendance and adverse events were evaluated. The database was maintained by a specialist nurse. Patients were contacted annually by the nurse via telephone to reassess for signs of relapse. Patient satisfaction with guided self-management as a method of follow up was evaluated by a questionnaire.
Results 50 patients (36M: 14F) were included. Median ages 45 yrs (18–74 yrs). 32 patients had ulcerative colitis (16 pancolitis, 8 distal disease and 8 proctitis) and 18 Crohn’s disease (9 terminal ileal disease, 9 Crohn’s colitis The median time of period of remission 36 months (8 mths–10 yrs). Of the 50 patients, 10 patient had a significant flare of their IBD (8 Crohn’s disease, 2 colitis) and required them to exit the self-management programme due to disease progression. Median time to exit was 24 months (10–48). 2 required surgery, 6 progressed to immunomodulators and 2 to biologic therapy.
Average clinic attendance for patients in remission (40 patients) was 1.9 hospital attendances within the five year period, with 2.9 appointments in primary care, all patients were treated with mesalazine and had annual blood tests. 26/33 patients with colitis required colorectal cancer surveillance, this was completed in 24/33 patients. All patients required a dexa scan in line with UK guidelines; this was completed in 75% of patients. Satisfaction with self-management remained high with 95% of patients scoring the method of follow up as good or excellent.
Conclusion Therefore, self-management is a safe long term strategy for patients with IBD, but does require support from a specialist nurse to ensure colorectal cancer surveillance, osteoporosis screening completed and annual telephone review is made available.
Disclosure of interest None Declared.
Kennedy AP, Nelson E, Reeves D, et al. A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease. Gut 2004;53(11):1639–1645
Robinson A, Thompson DG, Wilkin D, et al. Guided self-management and patient-directed follow-up of ulcerative colitis: a randomised trial. Lancet 2001;358(9286):976–981