Inflammatory Bowel Disease Advice Lines: A Scoping Review

Background Telephone or email advice lines offer a service that bridges primary and specialist care provision, supporting the needs of those living with an unpredictable disease course. This scoping review aimed to systematically synthesise published evidence with regards to Inflammatory Bowel Disease (IBD) advice line services and to identify gaps in research to inform further work. Methods A scoping review was undertaken in accordance with the patterns, advances, gaps, evidence and research (PAGER) framework1. Databases searched included CINAHL, PubMed and EMBASE. Inclusion/exclusion criteria were applied by two reviewers independently. Data were collected using a pre-defined matrix, from which the framework was applied as a means of systematically collating patterns, advances, gaps, evidence and research recommendations. Results 17 full text publications and 22 abstracts published between 2006 – 2023 were included. Four overarching patterns were identified: advice lines as a complex intervention, drivers for advice line encounters, patient outcomes, and economic impact of advice lines.Advice lines are commonly a nurse-led service, facilitating on-demand specialist advice and clinical care. They function as a complex intervention within growing IBD services, and are currently accessed for a variety of clinical and non-clinical reasons, although flare management and medication advice remain a common driver for access. There are significantly increased costs to wider healthcare, associated with frequent users of IBD advice lines. Conclusion The current evidence landscape lacks empirical research supporting the clinical and economic effectiveness of advice lines. IBD advice lines are commonly a nurse-led service functioning as a complex intervention, supporting both administrative and clinical issues. They appear pivotal in preventing use of acute services and escalating or re-directing care including treatment, investigation and advice. Further research should focus on robust clinical and economic evaluation for patients and services, exploring patient experience of advice line services, including barriers and facilitators, and characterising those who do not currently access the service.

Background Inflammatory Bowel Disease (IBD) is a chronic unpredictable condition of the gastrointestinal tract and advice lines for chronic disease are well established. Advice lines are a fundamental part of the Inflammatory Bowel Disease services. They offer advice and support for patients and have been shown that early intervention via an advice line can have a major impact in avoiding hospitalisation due to a flare up. Inflammatory Bowel Disease advice lines provide for multiple queries in relation to IBD and increasing demands were observed. The introduction and increased use of biologic medication (subcutaneous and oral) requires a repeat Hi Tech prescription and this has increased the workload through the IBD advice line. The aim was establish if aspects of the IBD advice line was in accordance with IBD Standards UK and to highlight any deficiencies that would require corrective action Methods Data was collected on all telephone calls received by the ANP IBD advice line during the data period 17/01/2022 to 11/02/2022 (n=80). The average number of monthly calls to the service is 146. Prospective data was collected by ANP IBD and analysed by the Clinical Audit Facilitator using IBM SPSS Statistics v 24. Criteria used to measure against: Rapid access to specialist advice should be available to patients to guide early flare intervention, including access to a telephone/email advice line with response by the end of the next working day ( IBD Standards UK) Results The highest number of calls to the advice line was 23/80 (29%) for a Hi Tech prescription. Flare up calls consisted of 21.2% of the calls and results investigations was equal to this. Administration queries and medication queries consisted of 7.5% of the calls. Clinical related queries were almost 9% of the calls. 59% of calls were returned within 36 hours. Mean interval of time call was returned was 34.7 hours and a median interval of 28 hours. Conclusion The audit indicates the highest number of calls are for repeat Hi tech prescriptions for medications. A Quality Improvement Plan includes the establishment of a dedicated Hi Tech Prescription Telephone/Virtual Clinic. This will also ensure an improved quality and a safer standard of care for patients. . The audit further identifies the number of calls and the effectiveness of the Inflammatory Bowel Disease advice line e.g. the number of calls (17/80) that dealt with a flare up that would have possibly attended the Emergency Department. It also highlights the time intervals for return of calls (33/80) calls were returned > 36 hours. A new Clinical Nurse Specialist Inflammatory Bowel Disease would improve service outcomes.

Recently the palliative care literature has emphasized the need for 24-hour telephone advice and support for patients during the last year of life. As some health professionals may lack skills and knowledge regarding palliative care issues, an out-of-hours (OoH) advice line is considered a valuable resource. This report provides an analysis of both qualitative and quantative data concerning the Mount Vernon Cancer Network telephone advice line (TAL) for 2008-2010. Data relating to the use of the TAL during OoH periods was collated and analysed on an annual basis. Data collected from a caller questionnaire relating to patient outcome, experience, and caller satisfaction was also evaluated. The number of calls to the OoH TAL increased by 13% over the 3-year period. The primary reason for the calls was symptom management, and 79% were made by patients' relatives. From the questionnaire responses, 66% of callers appeared to have a high rate of satisfaction, and 67% of patients were not admitted to hospital. It appears that the advice line is providing a highly valued service, with calls being managed by experienced nurses. Increasingly, local commissioners are placing greater emphasis on supporting care at home and reducing unnecessary hospital admissions, and advice lines seem to be an effective way of facilitating this.

BackgroundRheumatology telephone advice lines have become an integral part of rheumatology outpatient activities in recent years, falling within the remit of the clinical nurse specialists (CNS) workload. In a review...

Objective: Advice lines for patients with inflammatory bowel diseases (IBD) have been introduced internationally. However, only a few publications have described the advice line service and evaluated the efficiency of it with many results presented as conference posters. A systematic synthesis of evidence is needed and the aim of this article was to systematically review the evidence of IBD advice lines.Materials and methods: A broad systematic literature search was performed to identify relevant studies addressing the effect of advice lines. The process of selection of the retrieved studies was undertaken in two phases. In phase one, all abstracts were review by two independent reviewers. In phase two, the full text of all included studies were independently reviewed by two reviewers. The included studies underwent quality assessment and data synthesis.Results: Ten published studies and 10 congress abstracts were included in the review. The studies were heterogeneous both in scientific quality and in the focus of the study. No rigorous evidence was found to support that advice lines improve disease activity in IBD and correspondingly no studies reported worsening in disease activity. Advice lines were found to be health economically beneficial with clear indications of the positive impact of advice lines from the patient perspective.Conclusion: The levels of evidence of the effect of advice lines in IBD are low. However, the use of advice lines was found to be safe, and cost-effective. Where investigated, patients with IBD overwhelmingly welcome an advice line with high levels of patient satisfaction reported.

IntroductionPeople managing advanced illness at home require round-the-clock access to advice and support. Telephone advice lines are one approach to providing this, yet there is limited evidence on how to...

ObjectivesTelephone advice lines are a key component of National Health Service (NHS) rheumatology services and increased demand poses challenges for users and service providers. To explore the experiences of people using these services we undertook an evaluation survey with the National Rheumatoid Arthritis Society (NRAS).MethodsAn online survey, co-designed with people with lived experience, was distributed by NRAS between August and September 2024. The survey collected data on respondent demographics, reasons for contacting advice line services, experiences using the advice line and how services could be improved.ResultsA total of 1423 participants completed the survey. The majority were female [n = 1338 (94%)], of White British ethnicity [n = 1455 (95%)], had rheumatoid arthritis [n = 1288 (91%)], with a disease duration of >6 years [n = 975 (68%)] and were 61–80 years of age [n = 849 (56%)]. Most services were automated [n = 1273 (85%)], although participants would prefer to speak to someone directly [n = 889 (59%)]. The main reasons for contacting advice lines were experiencing a flare [n = 946 (66%)], pain [n = 876 (61%)] and medication concerns [n = 863 (61%)]. Most participants found the advice to be ‘helpful to very helpful’ [n = 847 (59%)] and were ‘confident to very confident’ [n = 866 (61%)] they could implement the advice given. A total of 839 (56%) calls were returned within 48 hours. There were 665 free-text responses on how telephone advice line services could be improved that focused on three main areas: increasing availability, improving response times and having more staff to deliver advice line support.ConclusionThe increasing demand for NHS rheumatology telephone advice line services requires a redesign of current systems to maximize accessibility and manage user expectations.

Telephone advice lines are a key component of rheumatology services. A national survey of telephone advice line providers was undertaken to explore how this service is currently delivered and the impact on those delivering it to inform providers, policymakers and patients. We conducted an online survey between March and September 2023 collecting data on demographics, how advice lines function, governance and the impact on nurses' well-being. Data were analysed using descriptive statistics. A total of 123 health professionals completed the survey. The majority were rheumatology nurses [n = 118 (96%)], >45years of age [n = 112 (91%)], band ≥7 [n = 92 (76%)], with 77 (65%) reporting >10 years of experience within rheumatology. Most advice lines operated weekdays only [n = 93 (79%)], with most calls returned within 2 days [n = 81 (66%)], although some callers waited >7 days [n = 19 (15%)]. The number of calls received monthly ranged from 100 to >800, with 46 (37%) responders reporting >500 calls/month. The most common reasons for contacting advice lines were disease activity, pain and medication concerns. For most responders, governance arrangements were unclear [n = 72 (61%)]. Providing advice lines impacted on the well-being of nurses providing the service: 89 (72%) felt anxious 'sometimes to mostly' and 79 (64%) found it 'mostly-always' stressful. A total of 85 (69%) nurses had not received any training to manage advice lines. Although telephone advice lines are provided by experienced rheumatology nurses, high demand is impacting on well-being. Having designated training could equip nurses with additional skills to manage increased capacity and monitor their own well-being.

Background/Aims Introduction: The Rheumatology service runs across three sites: Eastbourne DGH, Conquest and Bexhill Hospitals under ESHT with nurses and doctors working across these sites. We have two dedicated rheumatology nurse advice lines at Eastbourne DGH and Conquest hospital managing all queries daily and the existing service is overwhelmed. We are striving to deal with the current demands of this service due to the fast-growing number of messages collected through this adviceline Methods Aims and methods • To identify the number of calls, time spent, and the type of queries covered by two nurses over a 6-month period at one site. • To analyse the information, then recommend and implement a method on how best to ease the time spent on these messages and queries. • To achieve a solution enabling nurses to focus on providing urgent advice or clinical information. • To facilitate happy working hours in the department. Results Results: • Total number of calls: 1816 (average 16 calls /day). • 37%: Clinical advice (566) or information. • 24%: Chasing prescriptions, investigations and results: (373 & 380 respectively). • 10%: Admin related, clinical appointment and address changes: (156). • 2%: GP enquiries and Shared Care agreement questions (30) • 1%: Inappropriate calls. • Average time spent on dealing the queries: 1-15 minutes per call equating to over two hours every day. This data is likely to appear worse when there are staff absences, such as annual leave/sickness which must be taken in to account. Conclusion Conclusions: • The volume of calls continues to grow significantly. • Just above one third of the queries only were related to clinical advice or information • The project covered only one site, and the figures are expected to be worse if both sites are counted in the project. • Advice line can no longer be managed effectively or safely with the current capacity. • Some of the messages received, especially for non-clinical advice, can be handled / managed by admin staff. Recommendations and implementation of change: • The project is being extended to the other hospital site • Limit the amount of time advice line is open • Patient Knows Best service, access to and use messaging service reducing the time spent, allowing nurses to concentrate on urgent clinical queries. • Additional staff recruitment in progress • Dedicated email for queries, admin staff to monitor this and provide non-clinical advice. • Advice line rota for a nurse’s dedicated to combine single advice line. Acknowledgements: Dr.S.Panthakalam. Consultant Rheumatologist Disclosure A. Hall: None. N. Powers: None.

Background/Aims Rheumatology telephone advice line services are struggling to manage increased patient demand. A survey of people with rheumatology arthritis (RA) by the National Rheumatoid Arthritis Society (NRAS) was undertaken to explore the experiences and expectations of telephone advice lines users. Methods A 4-week online survey, conducted in August 2024, collected data on demographics, how telephone advice lines function, reasons for contacting the service, whether the advice received was helpful and response times. Ways in which services could be improved was also sought. Data was analysed using descriptive statistics and thematic analysis for free text comments. Results A total of 1423 participants completed the survey. The majority were female (n = 1338, 94%), white (n = 1455, 95%) had RA (n = 1288, 91%), with a disease duration of over 6 years (n = 975, 68%) and aged 61-80 years (n = 849, 56%). Most services were automated (n = 1273, 85%), although the preference was to speak to someone directly (n = 889, 59%). 836 (57%) felt that they were listened to in a supportive way. 989 (69%) participants had contacted the service 1-3 times over the last year and 847 (57%) were ‘very likely’ to use the advice line in the future. Participants were made aware of the telephone advice line by the rheumatology nurse (n = 1025, 72%) and it was the main health service participants contacted if they had a problem with their rheumatology condition (n = 1194, 84%). The main reasons for contacting the advice line were experiencing a flare (n = 946, 66%), pain (n = 876, 61) and concerns about medicines (n = 863, 61%). Most participants found the advice given to be ‘helpful-very helpful’ (n = 847, 59%) and were ‘confident to very confident’ (n = 866) they could carry out the advice given. 839 (56%) calls were returned within 48 hours. There were 665 free-text responses on how telephone advice lines services could be improved and these focused on three main areas: 1) increasing the advice line availability. Many services were only operational for a few hours on specific days. People in employment favoured weekend availability. 2) A timely response especially when experiencing pain. Response times were increasing and some participants received no response describing the service as “a very hit and miss process”. 3) Respondents recognised that without adequate resources including sufficient numbers of nurses, services would not be able to respond to patient need. Conclusion Telephone advice lines are highly valued and commonly used by people with inflammatory arthritis. Participants clearly recognised the current pressures and the lack of nurses to respond to calls in a timely manner. There is a clear need for service providers to review current services to enhance the patient experience including; accessibility, call response times and adequate staffing These findings align with those of a recent national survey of nurses providing advice line support (Ryan et al. 2024). Disclosure S. Ryan: None. A. Bosworth: None. S. Matthews: None. K. Jones: None.

Background/Aims NICE guidelines recommend people with rheumatological conditions need rapid access to specialist care to manage flares and to advise on medication. With growing demand for NHS services, rheumatology advice lines are coming under pressure. We carried out an audit on our advice line queries over four clinics in summer 2021 with a view to developing a triaging system to improve response time. Over four advice line clinics, there were 44 calls averaging 13 minutes per call. The response time was two to three weeks. 34% of calls were deemed to be inappropriate. Inappropriate calls were considered ones that could be better directed elsewhere. Methods In 2022 we started working with DrDoctor, a digital health company to design a digital nurse advice line form to redirect inappropriate calls away from the nurse advice line call backs. This involved designing a digital pathway addressing common inappropriate themes from our audit including redirection of calls to secretaries, patient booking team, prescription management and a digital booking form for phlebotomy appointments. The new digital tool enabled us to expand the service and we used the opportunity to adopt patient assessment tools and educational videos as part of the service. We promoted the digital pathway through patient information leaflets, department website and sent a text with the link to all rheumatology patients. We continued to offer the traditional contact telephone number into the service as well. Results The digital nurse advice line went live at the end of July 2023 and after two months the response time has reduced to 1.5- 2 weeks. Since then there have been 529 form submissions from 417 unique patients. 47% of submissions were inappropriate and redirected. 97 patients called to book a blood test and 76 patients opted for the online self-service clinic. 151 patients had a query about their condition. 50% of patient had RA or inflammatory arthritis. 5% AS. 5% SLE. 17% PsA. 23% selected ‘other’ and a free text box captured conditions such as fibromyalgia, osteoporosis, PMR and OA. 26% of patients with rheumatoid arthritis opted to see the educational video on self-examination and 17% watched the educational video on rheumatoid arthritis. Based on 251 submissions that were inappropriate for the advice line, assuming each inappropriate call takes an average of nine minutes based from our previous audit, 39 hours of phone time was saved from avoiding booking inappropriate nurse advice line appointments in two months. Conclusion The digital rheumatology advice service is an efficient and effective method of responding to patient queries and can be a source of patient education and self assessment. Informal patient and staff feedback has been positive and we will be collecting formal feedback as the service becomes more established. Disclosure K. Nadesalingam: None. C. Short: None. K. Christian: None. P. Helliwell: None.

One of the primary goals of our nurse-led telephone advice line is to enhance and support self-management of our rheumatology patients. Over the recent years, evaluation of such nurse-led advice lines has been proven to be beneficial in such areas as promotion of self-management. One potential area in promotion of self-management is the area of biological therapies among inflammatory arthropathy patients. Patients receiving biological therapies have been shown to have an increased risk of infections. In response to this, prior to commencing biological therapies, all our rheumatology patients are educated in relation to infections while prescribed biological therapies and also regarding deferral of biological therapy while receiving antibiotic treatments. An information pack, with relevant advice concerning individual biological therapy, is also given to patients. Those on intravenous (I.V.) biological infusions are advised to contact the nurse-led advice line if on antibiotic treatment during the week prior to infusion, to facilitate a potential IV biological therapy schedule adjustment. The aims of this education programme are to empower patients and promote self-management. Recently, we conducted a retrospective audit of all calls received by our nurse-led advice line, in relation to antibiotic usage over a period of 6 months, was carried out (July–Dec 2009). Recorded data included the nature of call, the number of calls received, patients’ demographics and source of call (patient, carer or primary care team). The primary objectives were to: (1) assess the calls received by the nurse-led advice line in relation to antibiotic treatment while on biological therapy and (2) promote patient confidence and encouragement to enhance self-management on biological therapies. A total of 30 calls were received relating to antibiotic treatment while on biological therapies. Twenty-seven patient calls (90 %; 9 female, 18 male) and three general practitioner (GP) calls (all female patients) were received. Twenty-four calls (80 % of all calls) related to subcutaneous biological therapies of which 12 (50 %) calls resulted in deferral of subcutaneous biologics for one dose only. Six calls concerned IV biological therapies, with no call resulted in rescheduling of IV biological therapy. In conclusion, our nurse-led advice line has been shown to be beneficial in minimising missed biological therapies while receiving antibiotic therapy. The number of calls in relation to antibiotic treatment while on biological therapies was higher than expected. However, no follow-up call was received following the advice given. Following consultation with rheumatology nurses, rheumatologists and pharmacists, a decision has been made to develop an information leaflet, giving clear explanations on management, for all patients receiving antibiotics while on biological therapies. A guidance document published by the Royal College of Nursing supports this new approach [1].

Introduction Dedicated specialist advice lines for patients with IBD (Inflammatory bowel disease) are recommended by the BSG [Lamb CA, et al. Gut 2019;0:1–106] to help prioritise rapid access to advice and specialist clinical input. This project evaluated the efficacy of the service in a tertiary London hospital, particularly its role in managing patients concerns and avoiding hospital admission. Methods A retrospective audit of 1000 IBD patient calls between August 2019 and October 2019 was conducted. The help line covered patients across all Imperial Trust sites – Charing Cross, St Mary’s and Hammersmith Hospitals. The data collected included the following - Time of call, diagnosis, mode of contact, when the call was answered, number of attempts, advice given by whom, call reason and outcome. Results The divide between UC and Crohn’s was approximately equal (46.3% vs 48.5%). Out of the 1000 the majority (809) were direct patient contact. Voicemail was the most common mode of contact (577) followed closely by email (435). 84% of patients were answered on the same day, 12% the next day and 4% on another day. 84% of patients got through on the first attempt while 11% needed a second attempt and 5% required three attempts. Majority of the advice was given via telephone (70%), the second most common was email (24%). Most calls (25%) were regarding investigation/treatment, 21% regarding flares, 12% results, 11% admin, 11% advice, 7% homecare, 4% earlier appointment and 4% side effects. Regarding outcomes – 28% involved investigation/treatment, 13% repeat prescriptions, 13% results, 12% advice, 7% appointments, 5% admin, 3% dose escalation, 3% home care, 3% contacted the consultant, 2% biologics switch, 2% A&E/urgent care referrals and 1% support. Conclusions The service was highly efficient; 85% of calls were answered The majority of calls and outcomes related to investigation, treatment and disease flare-up – demonstrating that the service is being used appropriately. Only 2% of patients required A&E/urgent care referrals, demonstrating that access to specialist advice can reduce or avoid costly hospital admissions. These data are in keeping with systematic reviews that have all shown advice lines to be safe and cost-effective. Medication advice and monitoring was a common use of the advice line – this remote service helps provide a robust platform for toxicity surveillance. In order to maintain the high quality of the service, ongoing IBD Nurse education and prescribing, can help maintain high levels of efficiency, good patient care and a high level of patient satisfaction.

Background: Telephone advice lines have been recommended internationally to support around-the-clock care for people living at home with advanced illness. While they undoubtedly support care, there is little evidence about what elements are needed for success. A national picture is needed to understand, improve and standardise service delivery/care. Aim: To explore telephone advice lines for people living at home with advanced illness across the four UK nations, and to construct a practical framework to improve services. Design: A cross-national evaluation of telephone advice lines using structured qualitative interviews. A patient and public involvement workshop was conducted to refine the framework. Setting/participants: Professionals with responsibilities for how palliative care services are delivered and/or funded at a local or regional level, were purposively sampled. Results: Seventy-one interviews were conducted, covering 60 geographical areas. Five themes were identified. Availability: Ten advice line models were described. Variation led to confusion about who to call and when. Accessibility, awareness and promotion: It was assumed that patients/carers know who to call out-of-hours, but often they did not. Practicalities: Call handlers skills/expertise varied, which influenced how calls were managed. Possible responses ranged from signposting to organising home visits. Integration/continuity of care: Integration between care providers was limited by electronic medical records access/information sharing. Service structure/commissioning: Sustained funding was often an issue for charitably funded organisations. Conclusions: Our novel evidence-based practical framework could be transformative for service design/delivery, as it presents key considerations relating to the various elements of advice lines that may impact on the patient/carer experience.

Introduction and Objective: Type 2 diabetes care is underpinned by patient education, evidence-based therapy, complication surveillance and timely intervention. Patients sometimes need urgent specialist advice to prevent emergency room (ER) and extra outpatient (OP) attendance and for reassurance. We offer OP care, website support, and 3 lines: Emergency Advice Line (EAL) - immediate specialist advice 8AM - 10PM weekdays and 8AM - 4PM weekends, and Non-urgent Patient/Carer (NU-P) and Non-urgent Clinician (NU-C) advice within 24-hr. Objective - to assess impact of clinical support lines on ER and extra OP attendance. Methods: We assessed line activity and impact October 2021 to November 2023 in 5,809 contacts (mean 232 pcm): EAL (452 [7%]) - 18 pcm, NU-P (2531 [44%]) - 101 pcm and NU-C (2826 [49%]) - 113 pcm. After contact, diabetes specialists gauged whether consultation likely prevented ER or extra OP attendance. We used hospital records to test specialist judgements in 100 consecutive patients and found specialists accurately predicted 28-day ER prevention and OP referral prevention in 98% and 93% patients respectively. Results: For EAL, 75% calls were patients and carers and 25% non-specialist clinicians. Over 25-months, EAL calls fell 17%, but NU-P and NU-C grew by 63% and 36% respectively. Conclusion: Timely advice and reassurance are invaluable, but our experience suggests advice lines may also prevent ER and extra OP attendances. Disclosure G.A. Lewis: None. L.J. Mitchell: None. K.J. Hardy: Other Relationship; AstraZeneca, Sanofi.