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Research
The impact of an inflammatory bowel disease nurse-led biologics service
  1. Nicola S Taylor1,
  2. Marion Bettey1,
  3. Julia Wright2,
  4. Caron Underhill3,
  5. Sarah Kerr2,
  6. Kim Perry4,
  7. JR Fraser Cummings1
  1. 1Department of Gastroenterology, Southampton General Hospital, Southampton, UK
  2. 2Pharmaceutical Commissioning, Eastleigh, UK
  3. 3Department of Pharmacy, Southampton General Hospital, Southampton, UK
  4. 4Department of Finance, Southampton General Hospital, Southampton, UK
  1. Correspondence to Dr JR Fraser Cummings, Department of Gastroenterology, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; fraser.cummings{at}uhs.nhs.uk

Abstract

Introduction Southampton General Hospital provides inflammatory bowel disease (IBD) services for a population of 650 000. Biological agents have impacted hugely on IBD but are costly drugs requiring careful supervision. These challenges led us to develop a specialist nurse-led biologics service to improve patient care.

Method A 2010 case note audit highlighted areas for improvement in monitoring biologics and follow-up. A business case was developed to establish an IBD nurse to ensure identification and appropriate screening, education and review of biologics patients. A gain share was agreed with the local Care Commissioning Group (CCG) and £60 000 invested. Outcomes were reaudited in 2014.

Results Biologic use has grown rapidly from 90 patients in 2011 to 330 in 2014. All records are now kept in a centralised database. Infection screening improved from 79% to 100%. In 2014, 96% of patients had follow-up ≤4 months post-induction to assess response, but two patients were seen at 7 months. 80% were followed up again at 9–12 months (100% at 9–14 months), all with treatment decisions. The initial investment was recouped via commissioners funding 368 additional outpatient appointments and 35 colonoscopies. Savings represented 15% total yearly biologic costs.

Conclusions The introduction of the IBD biologics nurse-led service resulted in significant gains in care quality and costs. The need for improved follow-up of patients on biologics reflects increased pressures on clinic resources across the country. With continued biologics expansion, the introduction of a biologics nurse has provided invaluable support to patients and the IBD team at Southampton General Hospital.

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