PTU-075 What is the benefit of telephone and virtual IBD clinics in a DGH?

Abstract

Introduction Inflammatory Bowel Disease (IBD) services across the UK are under increasing pressure. To improve efficiency, pathways of care have been proposed. However these are difficult to cost due to a lack of data on current service provision, leading to challenges with commissioning. We set out to characterise our IBD service in a District General Hospital (DGH) setting, having recently implemented a new pathway to streamline the service. A second aim was to establish if our service met the NICE quality standard of seeing IBD referrals within 4 weeks. Methods Prospective data from clinics at two DGHs were gathered from 92 patient journeys over 52 weeks. The activity of a new IBD helpline was analysed over a 28 week period and outcomes prospectively recorded. Specifically the activity avoided as a result of the helpline was analysed and costed. Finally, the outcomes from a new virtual IBD clinic were prospectively collected over a 10 week period. Results 33% of clinic patients had IBD, of which 59% were in remission. 41% of patients were felt suitable for non-clinic follow-up. 76% were interested in the concept of ‘self-management’ during remission. 95% of patients rated the consultation experience as ‘good’ or ‘very good’. There was an average 1 new to 4 follow-up encounters within the first year from referral; 26% were successfully conducted by telephone. Median time from initial referral to first outpatient contact was 9.1 weeks (4.9–19.9). 58% were not seen within 4 weeks of referral. The IBD helpline received 543 calls in 28 weeks (average 83/month). The interventions avoided due to this service were; 156 GP consultations, 231 outpatient reviews, 39 ED attendances and 6 admissions. Estimated cost saving due to activity avoided was £37,913, with helpline costs of £2065. 92% of patients rated the helpline as ‘good’ or ‘very good’. 100% of patients reported a response within 24 hours (weekdays). Since September 2017, 10 virtual IBD clinics have led to 191 treatment decisions. High cost biologic drugs have been stopped in 7 patients, without having to wait for face-to-face review, with an estimated saving of £12 300. 59 patients were identified as needing annual review and 51 identified as needing urgent treatment decisions. Overall quantifiable cost savings from the helpline and virtual clinic totalled £11,000/month. Conclusions Telephone and virtual clinics result in earlier treatment decisions for IBD patients and give quantifiable cost savings as part of an IBD pathway at a DGH. By increasing virtual clinics and encouraging patient autonomy, we can aim to improve the NICE quality standard of seeing new IBD patients within 4 weeks of referral. Improving autonomy over services for both clinician and patient can allow for more efficient IBD care.