Introduction The management of biologic therapy in IBD poses many challenges to clinicians. The U. K. IBD Standards1have highlighted the need for a structured approach to the view of patients, but this can prove difficult as a result of limitations in outpatient capacity. The gastroenterology team aimed to evaluate the impact of a multidisciplinary team (MDT) meeting on clinical outcome and cost efficiencies.
Method A one hour weekly MDT meeting was established to review all in-patients with IBD and those receiving biologic therapy. In addition, clinicians discussed cases that required additional opinions in management. This was attended by Consultant gastroenterologists, IBD Nurse Specialists, dieticians, junior medical staff and consultant surgeon. Outcomes from the meeting where recorded on a database and prospectively audited.
Results Within a 6 month period the IBD team meet on 22 occasions. 257 patients where reviewed (120 male, 137 female median age 36 (16–77) with IBD (210 Crohn’s disease, 39 ulcerative colitis and 3 pouchitis and 5 IBDU). Biological therapy was reviewed in 182 cases, including 136 patients requiring a routine annual review of therapy. Of the latter group, biological therapy was continued in 112/182 (61%) cases, based on continued disease activity. 18/182 (9%) patients where referred for further investigation to evaluate response to treatment and 6 where referred for outpatient clinic review. Clinical management was reviewed in 46 patients, and subsequently 18/46 patients had treatment de-escalated or ceased as a result of clinical improvement or mucosal healing. 8 patients with adverse events were reviewed and a further 8 patients had their biologic changed. 2 where referred for discussion at the medical surgical MDT. Endoscopy referrals where requested in 20 cases, MR scan in 7 cases and an urgent clinic appointment in 23 cases.
A further 75 patients raised for general discussion regarding clinical management. 10 were in-patients, and 3 were referred for surgical review, a further 7 had treatment progressed to anti-TNF therapy. 6 patients had endoscopic findings that required discussion. 30 patients where general discussion surrounding immunomodulating therapy. 7 patients had abnormal Liver function tests which required onward referral to hepatology. 22 patients had issues around general IBD management.
Audit of compliance with NICE guidance improved from 80% to 100%. De-escalation of therapy and cessation of therapy accounted for a cost saving of £185,000
Conclusion The development of a nurse co-ordinated team meeting for IBD patients has facilitated a significant improvement in the overall quality of patient care, and has resulted in significant savings.
Disclosure of interest None Declared.
RCP standards for patients with inflammatory bowel disease. London: Royal College of Physcians, 2013