Introduction/Background Treatment with anti-TNFα agents for paediatric patients with moderate to severe IBD has received increasing regulatory approvals since 2006. Treatment with Adalimumab and Infliximab was made available at Milton Keynes University Hospital, a secondary care setting in the Thames Valley region, following design of a shared care protocol in 2016. The service is resourced by local PeGHAN Consultant, Community Nursing team, Day Care unit and Pharmacy provisions supported by tertiary clinicians.

Aim We set out to establish both the efficacy of the service and levels of patient satisfaction by conducting a survey of our current cohort of 12 IBD patients living in Milton Keynes and receiving treatment with biologics at our unit.

Subjects and Methods Our survey included the evaluation of data from electronic patient records (EPR) and telephone interviews. All patients have experience of the local service although three are presently on a regimen only available at the tertiary centre.

We looked at several aspects of their care including current choice and length of biologic treatment, evidence of remission, occurrence of adverse reactions, monitoring parameters and outpatient follow up arrangements.

Our telephonic patient questionnaire focused on whether families felt they were given sufficient information about treatment, the impact of receiving treatment locally and overall satisfaction with the service.

Results Of our 12 patients with IBD, 2 were diagnosed with Ulcerative Colitis and 10 with Crohn’s disease. All are children of school age with an age range from 7 to 17.5 years.

9 children are eligible for local treatment, 7 of them receive Adalimumab injections and 2 children are treated with Infliximab infusions. The 3 children treated with Vedolizumab or Ustekinumab have previously received at least one other biologic locally. Treatment duration ranges from 2- 49 months on their current biologic, with a mean duration of 16.5 months.

6 children started their treatment at MKUH, 3 at Oxford but continued at MKUH. The remaining 3 started at Oxford to continue locally but went back to Oxford due to treatment failure. Initial biologic therapy had to be switched in 6 children due to suboptimal response. All families reported their child as now clinically well. Only 5 children achieved Calprotectin levels below 200µg/g. The mean CRP was 1.4. Monitoring is done regularly with quarterly reviews at the joint IBD clinic.

All families feel they were given adequate information about treatment and accessible contact points for queries. Formal training was given to all families administering Adalimumab at home by local community nursing team. Easy access to all health care professionals involved in the service was especially praised and appreciated. Parents feel the service is patient centred and individualised. There were no serious adverse events. Families described that local access meant less disruption to their child’s lifestyle and education.

Summary and conclusion Treatment with biologics at secondary care hospital is safe, effective and contributes significantly to patient satisfaction.

Families feel well supported and appreciate the personalised care and accessibility of the service.