In the IBD Unit: Summary.

Abstract

The logistic issues facing the inflammatory bowel disease (IBD) clinician in 2016 are of equal magnitude to the scientific issues that are advancing the field at such a rapid rate. The expansion of therapies and therapeutic strategies, especially in the last 10 years, has not been matched by an increase in the resources that are required to deliver this state of the art care to our patients. Dr. Greg Moore, the current chair of the Australian IBD Association and Director of IBD at Monash Health, outlined national initiatives to quantify and subsequently improve the quality of IBD care in Australia. The high economic burden of IBD in Australia was discussed, as illustrated by an external accounting review in 2013, followed by presentation of results of the UK IBD audit. This demonstrated that IBD was grossly under-resourced compared with other chronic diseases, but that quantification of this disparity with accurate audit data resulted in improvements in resources such as the number of IBD nurses within a short period of time. This lead to an introduction to the Crohn's and Colitis Australia IBD Audit currently underway. The audit data will be used as advocacy for improved IBD funding, and all centers with an IBD service are urged to participate. Without data, funding requests to state and federal governments are unlikely to be successful. Dr. Peter de Cruz, Director of IBD at Austin Health, gave an informative overview of the changing models of care in IBD that are emerging as means of managing increasingly complex treatment strategies expanding beyond the boundaries of the usual patient clinic or office visits. These new models of care have arisen concurrent with advances in digital technology and new treatment strategies in IBD that are incorporating objective treatment endpoints rather than traditional symptom-based care. Research into the use of “E-Health” in IBD from Europe has demonstrated that digital algorithmic patient self-management plans can provide an efficient alternative to cumbersome, time-consuming hospital clinic visits, particularly in patients with milder disease phenotypes. Dr. de Cruz's research team are currently researching the use of E-Health strategies in patients with mild–moderate ulcerative colitis, a patient subgroup in whom non-clinic-based treatment strategies have been used effectively. Belinda Headon, IBD nurse consultant at Alfred Health, discussed the enormous administrative workload that is required to effectively deliver biologic therapy to IBD clinic patients. Using the Alfred's clinic as a model to demonstrate the increasing use of biologic therapies, the presentation contained multiple practical tips to help navigate the complex logistic and paperwork processes required to obtain these therapies via the Pharmaceutical Benefits Schemes. This presentation was consistent with recent local data that has shown that IBD nurses now devote more than half of their time to the logistics of delivering biologic therapy—an increase in workload that has not been matched by an increase in personnel. Professor Jane Andrews from Royal Adelaide Hospital has been at the forefront of recent advocacy efforts to improve IBD resources and IBD nurse funding in particular. She presented data her research team obtained from two South Australian hospitals that have been instrumental in forming a business case demonstrating the cost-effectiveness of IBD nurses to hospitals and health services. Her message to those seeking to obtain hospital-funded IBD nursing positions was clear—“Speak Up!”. She discussed the firm negotiating that was required to achieve funded positions at her institution, backed up by accurate local data that will hopefully be replicated by the current Crohn's and Colitis Australia IBD Audit. Finally, Dr. Mark Ward, from Alfred Health, outlined a creative solution to managing the increasing workload of IBD care—the virtual clinic. Beginning with his experiences with virtual clinics at St. Thomas' Hospital in London, he then discussed the virtual clinic that The Alfred has set up to manage the subset of patients receiving additional compassionate anti-tumor necrosis factor therapy. In addition to data on clinic numbers and outcomes, a potential business model including reimbursement billing options was presented. This novel concept requires validation in the Australian healthcare environment, but it may emerge as another model of care that can be used in our increasingly complex therapeutic landscape.