Introduction.

Abstract

Infusion centers provide a unique opportunity to provide care in a different way to inflammatory bowel disease (IBD) patients. When considering specialist care for IBD patients, there is a range of settings where this may be delivered. Each of these settings differs in the way in which care can be delivered (Table 1). Unlike other clinical settings, infusion centers have a number of specific characteristics that provide an opportunity to improve the totality of IBD care for an individual patient. Unlike many settings, the infusion center offers a significant period of time when patients are focused on their disease, receiving a therapy and able to be engaged in decisions and health promotion. While the primary purpose of the infusion center is to deliver infusions, the opportunity to add value to the patient interaction should not be missed. Core therapies that should be offered in all IBD infusion centers in Australia include biologic drug infusions including vedolizumab and infliximab (both originator and biosimilar). These therapies are highly effective for the induction and maintenance of remission of both Crohn's disease and ulcerative colitis.1, 2 In a treat to target era where IBD physicians and their patients strive for symptomatic and mucosal healing, regular assessment before making treatment decisions is a vital aspect of IBD care.3 Intravenous iron therapy is a simple therapy that can have a significant impact on quality of life. IBD patients may not always tolerate oral iron, and with new, rapid iron infusions such as ferric carboxymaltose able to be given as a 15-min infusion, this improves patient outcomes without the need for prolonged periods in the infusion center.4, 5 Inflammatory bowel disease nurses are key people in the infusion center. Organizing infusions including biologic bureaucracy and paperwork, delivering infusions and making the most of the opportunity of having patients in the IBD care environment are all vital for a functional infusion center.6 Opportunities to deliver extra care through the infusion center include advice on smoking cessation, nutritional assessment, surveillance timetabling (colon, bones, skin, and cervix), psychological comorbidity screening and intervention, and contact with social workers to ensure benefits are used appropriately, and IBD education to improve adherence and knowledge. Many of these areas of care have been described as unpromoted issues by Andrews et al.7 and may be addressed to some extent in the infusion center. However, the unique skill mix of the IBD nurse is central to the effective delivery of such holistic care. There is a range of options for the preparation of infusions including being made up in the infusion center, hospital pharmacy, and by third parties who prepare the drug to order off site. Decisions regarding the way in which the biologic drugs are dependent on characteristics of the infusion center and the environment where it is housed. In conclusion, the infusion center is a unique opportunity to deliver more than just vedolizumab, infliximab, or iron. IBD nurses are key people in adding value to the infusion center experience, ensuring that IBD patients have a holistic IBD experience, promoting wider aspects of health.