Inflammatory Bowel Disease Service Research Articles

Substantial cost savings of ultrasound-based management over magnetic resonance imaging-based management in an inflammatory bowel disease service

Background Imaging is used to monitor disease activity in small bowel Crohn’s disease (CD). Magnetic Resonance Enterography is often employed as a first modality in the United Kingdom for assessment and monitoring; however, waiting times, cost, patient burden and limited access are significant. It is as yet uncertain if small bowel intestinal ultrasound (IUS) may be a quicker, more acceptable, and cheaper alternative for monitoring patients with CD. Methods A clinical service evaluation of imaging pathways was undertaken at a single NHS site in England, United Kingdom. Data were collected about patients who were referred and underwent an imaging analysis for their IBD. Only patients who underwent a therapy change were included in the analysis. Data were collected from care episodes between 01 January 2021–30 March 2022. Results A combined total of 193 patient care episodes were reviewed, 107 from the IUS pathway and 86 from the MRE pathway. Estimated costs per patient in the IUS pathway was £78.86, and £375.35 per patient in the MRE pathway. The MRE pathway had an average time from referral to treatment initiation of 91 days (SD= ±61) with patients in the IUS pathway waiting an average of 46 days (SD= ±17). Conclusions Findings from this work indicate that IUS is a potential cost-saving option when compared to MRE when used in the management of CD. This is in addition to the cost difference of the radiological modalities. A large, multicentre, prospective study is needed to validate these initial findings.

Patient and public involvementin the development of health services: Engagement of underserved populations in a quality improvement programme for inflammatory bowel disease using a community-based participatory approach.

Involving people with lived experience is fundamental to healthcare development and delivery. This is especially true for inflammatory bowel disease (IBD) services, where holistic and personalised models of care are becoming increasingly important. There is, however, a significant lack of representation of underserved and diverse groups in IBD research, and there are significant barriers to healthcare access and utilisation among minority groups in IBD. IBD centres need to be aware of these experiences to address barriers via service changes, improve interactions with local communities and promote meaningful engagement for improved health outcomes. A pragmatic community-based approach was taken to engage with leaders and members of underserved groups across 11 workshops representing Roma, Afro-Caribbean, people of African descent and the wider black, Asian and minority ethnic (BAME) communities, Muslim women, refugee community members, deprived areas of South Yorkshire, LGBTQ+ and deaf populations. Thematic analysis of field notes identified patterns of attention across the community groups and where improvements to services were most frequently suggested. Findings demonstrated several barriers experienced to healthcare access and utilisation, including language accessibility, staff attitudes and awareness, mental health and stigma, continuity of support, and practical factors such as ease of service use and safe spaces. These barriers acted as a lever to co-producing service changes that are responsive to the health and social care needs of these groups. Engaging with people from a range of communities is imperative for ensuring that service improvements in IBD are accessible and representative of individual needs and values. Local community leaders and members of community groups actively participated in the co-design and development of improvements to the IBDservice for a local hospital. Their contributions further informed a pilot process for quality improvement programmes in IBD centres.

P713 The introduction of an intestinal ultrasound service significantly reduces diagnostic endoscopy usage in an Inflammatory Bowel Disease service – The SCOPELESS Study

Abstract Background Endoscopic assessment is the gold standard for monitoring of inflammatory bowel disease (IBD) activity. Intestinal ultrasound (IUS) is increasingly utilised as a non-invasive, alternative disease monitoring strategy. Our study aim was to quantify and compare endoscopy usage for evaluation of IBD disease activity before and after the introduction of an IUS service. Methods A retrospective single-centre study was performed. Total numbers of lower GI endoscopies (ileocolonoscopy or flexible sigmoidoscopy) performed for luminal Crohn’s disease (CD) or ulcerative colitis (UC) disease evaluation were collected across two 5-year time periods: the pre-IUS era (2010-2014) and the IUS era (2015-2019). Endoscopies for dysplasia surveillance were excluded. The primary endpoint was a comparison of the cumulative number of endoscopies for IBD disease activity evaluation annually relative to the annual number of patients seen in clinic in the pre-IUS and IUS eras. Secondary endpoints included evaluating the number of endoscopies by individual year within each time period, endoscopies according to diagnosis (CD vs. UC), and the number of IUS performed within the IUS era. Categorical variables were compared using a Chi-squared test. A p value <0.05 was considered statistically significant. Results The number of endoscopies performed for IBD disease evaluation decreased from 576 in the pre-IUS era to 474 in the IUS era despite an increase in cumulative annual patient reviews (1985 vs. 3337 patient reviews, respectively). The annual number of endoscopies for disease evaluation per patient in the pre-IUS and IUS eras is illustrated in Figure 1. The proportion of cumulative annual endoscopies relative to patients reviewed across the 5-years reduced from 29 per 100 patients in the pre-IUS era to 14 per 100 patients in the IUS era (OR 2.47, 95% CI 2.15-2.84; p < 0.001). There was a reduction in total endoscopies for CD evaluation from 325 to 264 and UC evaluation from 251 to 210. The proportion of endoscopies performed for CD vs. UC was unchanged between the two eras (56.4% vs. 55.7%; p = 0.81). In the IUS era, a total of 3319 IUS were performed (2673 CD, 646 UC). This included 1467 IUS for assessment of suspected activity (44 per 100 patients/year) and 1852 IUS for objective confirmation of clinical remission (55 per 100 patients/year). Conclusion In the 5 years following introduction of an IUS service, the number of endoscopies performed for evaluation of IBD activity per patient was halved. IUS was performed for both assessment of disease activity and objective confirmation of clinical remission. The potential workflow and cost savings of reduced endoscopies for IBD disease activity evaluation are significant.

N39 Exploring the impact of an Inflammatory Bowel Disease Biologics Nurse on the management of a biologics service

Abstract Background Biologics nurses play a critical role in the management of patients receiving treatment for Inflammatory Bowel Disease (IBD).Their impact spans various facets of patient care and service management. Prior to December 2021 all patients who required biological therapy were reviewed by any member of the IBD nursing team. This review would entail a comprehensive history taken, screening bloods ordered and explained and a thorough ex[planation of the risks and benefits of the medication including a detailed explanation of the use of the drug. The nurses were also responsible for the preparation of biologic prescriptions and checking of bloods. With a number of nurses undertaking this can lead to duplication of work or patients not receiving medication timely. Methods A business was written to secure funding for extra nurses and was unsuccessful. At the time of the Covid pandemic workload escalated to an extent that the current IBD Helpline and nurse led clinics could not continue in their present form. Resulting in a suspension of nurse clinics which led to a backlog of reviewing patients who required biological therapy, thus delaying their treatment. A meeting was convened with the senior management team and staffing numbers were increased resulting in the development of a biologics nurse. Results A band 6 biologics nurse was employed who completely transformed the biologics service. One person completing a role independently assumes total responsibility for all of the tasks annexed to the role. This involved patients education and support, monitoring and assessment of patients, coordination and communication with patients and relevant departments. It also included quality improvement, patient advocacy, emotional support to patients and patient empowerment/ One person responsible for this role has now led to a reduction in complaints, more timely treatment, less missed treatment appointments and a single point of contact for patients and departments. Our biologics nurse has not only achieved all of these roles but has been fundamental in the biologic switch to more coast effective biological therapies. Conclusion The impact of a dedicated biologics nurse in an IBD service is significant. They enhance the overall quality of care, improve patient outcomes, and contribute to the efficient functioning of the service by ensuring proper management, patient education, and support throughout the treatment journey. The team have had an increased number of praise and favourable comments from patients, families and departments that interact with our service such as the Medical Day Unit. The introduction of this role has been invaluable to our service has increased to such an amount that the team could do with a second nurse in post.

P455 Deploying machine learning algorithms to stratify patients with inflammatory bowel disease using routinely collected electronic health records

Abstract Background Personalised medicine approaches are eagerly awaited to facilitate individualisation of medical care for patients with inflammatory bowel disease (IBD). Multiple approaches have already been explored in attempts to stratify patients into different prognostic trajectories. In this study we aimed to use machine learning algorithms to cluster patients based on their routinely collected electronic health records in an unsupervised approach. Methods We interrogated the rich electronic health records (EHR) of 619 patients with a diagnosis of IBD requiring an advanced therapy and attending the IBD service at King’s College Hospital (KCH), London, UK. Data for a seven year period (June 2016-May 2023) were included with variables that captured diagnosis, treatments, service utilisation and investigations. Ethical approval was provided following application to the KERRI committee (KCH committee for accessing anonymised HER). In a preliminary analysis, we employed a multi-step approach to analyse patient data, identify significant features through k-prototypes clustering and a combination of parametric and non-parametric statistical tests. We examined different cluster solutions up to six clusters. Results We included 38 quantitative and 32 qualitative variables for 350 patients with a diagnosis of CD and 269 with a diagnosis of UC. Missing data were addressed by imputation by k-NN, mode value and zero. In the context of the unsupervised learning approach, when k=3, key differentiating features included faecal calprotectin levels, body mass index, mean platelet volume, marital status, taking advanced therapy for less than 3 years, and service access (telephone or clinic appointments). Conclusion This first pass analysis suggests that patients who are relatively early in their journey with at least moderately active IBD take up more recourses of the IBD service. This associates also with their social circumstances. Further work will explore these interactions in more detail.

P620 A cost-effective Inflammatory Bowel Disease flare management pathway utilising rapid access intestinal ultrasound and nurse-led triage to achieve hospital avoidance with increased patient satisfaction

Abstract Background Timely inflammatory bowel disease (IBD) flare treatment improves outcomes, but quick differentiation from other symptom causes is challenging. We aimed to reduce unplanned hospital presentations with a novel IBD clinical care pathway (CCP) allowing appropriate early flare management, utilising nurse-led triage and objective assessment with rapid access intestinal ultrasound (RAIUS). Methods Prospective data collection from 15 November 2022 until 14 June 2023, including clinical outcomes, pre-specified criteria for healthcare utilisation impact, clinical coding data, and patient satisfaction surveys. A senior IBD nurse assessed patients using a symptom severity-based algorithm, utilising a modified partial Mayo score and Harvey-Bradshaw Index. Standardised blood and stool tests were collected. Based on clinical urgency, patients were discussed with their specialist, referred for RAIUS, or considered for planned hospitalisation if severe symptoms (bypassing emergency department (ED)). Results There were 211 episodes of care (EOCs), with 407 initial and follow up encounters. The median patient age was 34 (IQR 25-44), a majority female (66%), 54% with Crohn’s disease, and 61% bio-exposed. Most (78%, n=165) EOCs were for flare symptoms (mild 41% (n=69), moderate 49% (n=80), severe 10% (n=16)) and the remainder for non-flare concerns (n=46). Of those with flare symptoms, 36% (n=59) had medication optimisation for active disease (5% (n=11) started steroids), 41% (n=67) reassured of remission, 12% (n=19) aperients for faecal loading, 5% (n=8) referred for further investigations, 2% (n=4) seen urgently in colorectal clinic for perianal flare, 2% (n=3) electively admitted, and 3% (n=5) seen urgently in IBD clinic. RAIUS was performed in 56 EOCs (27%), showing active disease in 32% (n=18), response/remission in 43% (n=24), and faecal loading in 23% (n=13). After RAIUS, 52% (n=29) had IBD medication optimisation. Based on pre-specified criteria, unplanned hospitalisation was avoided in 10% (n=20) of EOCs, urgent clinic review avoided in 58% (n=123), and no direct impact in 32% (n=68), with a net saving of AUD$146418 (Figure 1). Clinical coding data showed lower hospital presentations (Figure 2). Only 7 patients (3%) had an unplanned hospital presentation within 30 days of CCP engagement (most after-hours) and 5 (2%) were seen urgently in IBD clinic. With the CCP, more survey respondents (n=60) were "satisfied" or "very satisfied" with the IBD service, increasing from 53% (n=32) to 85% (n=51). Conclusion Our novel CCP improved IBD care through timely assessment, with high patient satisfaction and cost savings. Better integration of nursing and intestinal ultrasound resources can improve IBD care.

P407 Validation of a newly developed patient-reported experience measure for people with Inflammatory Bowel Disease

Abstract Background Patient-Reported Experience Measures (PREMs) assess a patient’s healthcare experiences and are important to improve the quality of healthcare. A PREM specific to inflammatory bowel disease (IBD) was co-produced with service users. This study aimed to validate the PREM. Methods The IBD PREM contains 38-items and comprises three domains: ‘the care team’, ‘what matters to me’, and ‘living with Crohn’s or Colitis’. Scores can be calculated for each domain and summated to give a total score. Validation was completed on data collected from participants who completed the PREM every 3 months alongside the IBD-Control measure of disease activity at a single UK tertiary IBD service. The PREM was assessed for acceptability; reliability (internal consistency and repeatability); known groups validity; criterion validity and responsiveness. Face and content validity were completed before finalisation using ‘Think Aloud’ interviews. Results The dataset used for validation was extracted in September 2023 and contained responses from 287 participants (63% female, 89% White British, median age: 52) comprising 1,699 PREM responses between November 2021 and August 2023. Acceptability was demonstrated with very low rates of missing data (four items with >5% missing) and median submission duration of 4.8 minutes (IQR: 3.6 – 6.6). High Cronbach’s alpha scores (0.85, 0.97, 0.88 and 0.97 for each of the domains and total PREM score respectively) show internal consistency of the measure. However, the particularly high value on one domain and the total score suggest some overlapping items may remain. An intraclass corelation coefficient of 0.88 (95% CI: 0.85 to 0.91) suggests good repeat reliability over a two-week timeframe. Good comprehension of the measure by service users satisfied face and content validity. Known groups validity was supported with lower score on ‘living with Crohn’s or Colitis’ domain the for those with an IBD Control score of less than 13 by 0.38 (95% CI: 0.23 to 0.54), p<0.001). A low to moderate correlation of 0.37 (95% CI: 0.32 to 0.42) was found between the total PREM score and the IBD Control score, as expected. Ceiling and floor effects had a maximum of 6% demonstrating potential responsiveness of the PREM. The change over a year detected by those that stated that had experienced a change was 0.53 (95% CI: 0.41 to 0.66, n=38) on a five-point scale.Conclusion The co-produced PREM is an acceptable, valid, reliable, and responsive tool to measure experience of IBD care for quality improvement. Further work should assess the potential for item reduction as well as correlation to other related measures.

P496 Interdisciplinary student-led screening clinics can identify undernutrition, sarcopenia and mental health risk in ambulatory patients with Inflammatory Bowel Disease

Abstract Background The changing landscape of allied health practice has led to the emergence of student-led clinics as a resource to enable workforce capacity. Undernutrition, sarcopenia, and poor mental health are common in inflammatory bowel disease (IBD) and affect quality of life. Despite high prevalence, these co-morbidities are under-recognised due to lack of service capacity. This study aimed to determine the frequency of undernutrition, reduced physical performance and mental health risk identified by a novel student-led interdisciplinary screening clinic in ambulatory patients with IBD. Methods Sixteen final year dietetic, physiotherapy or exercise physiology students conducted 5-10 weekly half day interdisciplinary outpatient clinics within a tertiary IBD service between July and October 2023. Following training, students completed all aspects of the interdisciplinary consult under direct dietetic supervision. Risk screening assessments comprised of anthropometrics, depression anxiety and stress scale-21 (DASS21), subjective global assessment (SGA), short physical performance battery (SPPB), handgrip strength (HGS) and inflammatory bowel disease-nutrition screening tool (IBD-NST). Consecutive patients attending a tertiary IBD outpatient service were contacted to participate in the clinic following their gastroenterology appointment. Descriptive statistics were completed, and prevalence is presented as number (n) and percentage. Results Screening assessments were completed for 88 patients in the 15-week period (Table1). Patient acceptance was high with 86% of patients approached consenting to participate. High hip to waist ratio was present in 68% (n=60/88) of patients suggestive of visceral adiposity (Figure 1a). The IBD-NST identified mild nutrition risk in 5% (n=4/88) of patients and generated a referral to dietetics with a moderate nutrition risk in 21% (n=19/88) of patients (Figure 1b). Malnutrition was detected in 10% (n=8/88) of the patient population (Figure 1c). Mental health risk was elevated in 63% (n=50/79) of patients screened (Figure 1e, f, g). Physical impairment was present in 52% (n=46/88) of patients (Figure 1h &1i). The screening clinic generated 48 referrals through to varied allied health disciplines for individualised therapy. Conclusion A student-led interdisciplinary screening clinic ensures timely identification of patient risk for undernutrition, sarcopenia and poor mental health, improving access to early intervention opportunities. Students can act as a valuable enabler for workforce capacity at a time when the health service providers are stretched.

P1030 Inflammatory Bowel Disease helpline contact trends in a real-world Australasian cohort: Crohn’s Colitis Cure (CCC) data insight’s program

Abstract Background For optimal outcomes, Inflammatory Bowel Disease (IBD) necessitates lifelong engagement in care. Specialized-IBD-nurse-led helplines improve access to care and reduce associated costs1,2. Despite this evidence, IBD nurses and helplines receive variable funding and little is known about their use across care sites. We therefore analysed IBD-helpline usage in a large, multi-site real-world Australasian cohort. Methods Crohn’s Colitis Care (CCCare), is a cloud-based IBD-specific electronic medical record used in Australia and New Zealand. It includes a "Helpline" tab to support helpline encounter documentation during the point of contact. All entered data feed into an associated, de-identified clinical quality registry (CQR). Helpline-associated data fields, including contact reason and type, were extracted from CCCare’s CQR in November 2023. Data from 6 large adult care sites across Australia and New Zealand were analysed. Results In 2022, a total of 6,717 helpline encounters were documented. There was a roughly equal split in contact type; phone accounting for 50.9% (n=3,416) and email for 49.1% (n=3301). The most common reasons for contact were related to medications (n=2,577; 38.4%), investigations (n=1,719; 25.6%) and clinical (n=1,060; 15.8%). More encounters were seen in 2023 (to date of data extract), with 7,540 helpline entries to date (Figure 1). In 2023, the most common form of patient contact was email (70.3%), with phone contact accounting for only (29.8%). The most common reasons for contact were again related to medications (n=2,577; 31.1%), investigations (n=1,162; 22.0%) and clinical (n=1,439; 19.1%). In both years, helpline activity was lowest in January and February, perhaps corresponding to the Holiday season (southern hemisphere summer). Conclusion A number of helpline entries were recorded across these 2 years, with activity lowest each summer. The data show a shift in the predominant mode of contact from phone to email in 2023, reflecting evolving communication preferences and making scheduling of helpline support easier. 1 - Nicolaides S, Vasudevan A, Van Langenberg D. Inflammatory Bowel Disease Helpline Reduces Subsequent Inpatient Admission Rates. J Crohns Colitis. 2020 Feb 10;14(2):281. doi: 10.1093/ecco-jcc/jjz141. PMID: 31374121. 2 - Karimi N, Sechi AJ, Harb M, Sawyer E, Williams AJ, Ng W, Connor SJ. The effect of a nurse-led advice line and virtual clinic on inflammatory bowel disease service delivery: an Australian study. Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e771-e776. doi: 10.1097/MEG.0000000000002249. PMID: 34402467.

P825 Comprehensive dietitian-delivered dietary advice effectively achieves dietary change in adults with Ulcerative Colitis, whereas generalised written dietary advice does not

Abstract Background Diet is an important consideration in microbial therapy trials. It is unclear whether provision of generalised written dietary advice is sufficient to induce dietary change as part of a therapeutic regimen or whether personalised diet advice is required. This study examines the effectiveness of different dietary advice modes provided in dietary and faecal microbiota transplantation (FMT) studies in adults with mild-moderately active ulcerative colitis (UC). Methods This observational study examined before and after dietary intake data from three prospective dietary and FMT studies held from 2018 to 2021 at a South Australian tertiary inflammatory bowel disease service. In all studies, adults ≥18 years with mild-moderately active UC completed 3 or 7-day weighed food diaries measuring habitual diet at 0 and 8 weeks after provision of dietitian-developed dietary advice. In studies one and two, a medical officer provided participants a written UC healthy eating pamphlet. The pamphlet contained generalised dietary recommendations for UC, targeting reduction of total and animal protein and increasing fermentable fibres including resistant starch to recommended serve sizes. In study three, a research dietitian provided a 1-week guided meal plan, diet manual with recipes and verbal personalised dietary counselling advising on the same recommendations and strategies. In all studies, participants were encouraged to eat to appetite. Dietary intake, including key nutrients of interest (protein and fermentable fibres), at weeks 0 and 8 was assessed using Foodworks 10TM nutritional analysis software and analysed using paired statistical tests. Results Across studies one and two, 28 adults with mild-moderately active UC received written dietary advice. In study three, 30 adults received personalised verbal and written dietary advice. Outlined in Table 1, verbal and written advice significantly reduced total protein and animal protein intakes by 20% (p=0.007) and 34% (p=0.002) respectively. Total fibre and resistant starch intakes significantly increased by 64% (p<0.001) and 353% (p<0.001) respectively. Comparatively, written advice alone had no significant change on any key nutrient intakes. Neither dietary advice mode significantly changed energy or micronutrient intakes. Conclusion Written dietary advice alone was insufficient to achieve dietary change. In contrast, verbal and written dietary advice with the same intended change on dietary intake, delivered by a research dietitian effectively achieved dietary changes. This emphasises that comprehensive written and verbal dietary education delivered by a dietitian should be included in microbial-modulating study designs where dietary change is an intended outcome.

Increasing Exposure to Inflammatory Bowel Diseases Education in Gastroenterology Fellowship: The Pilot IBD 101 Experience.

Inflammatory bowel disease (IBD) management has become increasingly complex, and education varies across fellowship programs. IBD 101 was designed to introduce first-year gastroenterology (GI) fellows to IBD care and training. In 2019, a cohort of fellows participated in a 1-day course with small group learning and group observed structured clinical examinations. Pre- and postcourse surveys were administered to evaluate the course. To assess the long-term impact, surveys were emailed in May 2022 to all third-year fellows from previously participating programs. The primary outcome was comfort managing IBD scenarios and information regarding each fellow's exposure to IBD education. Fifty-five fellows from 32 programs participated. A total of 49 (89%) of 55 completed pre- and postcourse surveys. All fellows agreed that the course content was appropriate. In the postcourse survey, all fellows reported increased comfort managing IBD patients. Ninety-six percent of attendees stated that they would strongly recommend this course. Thirty-six fellows completed surveys in 2022, 21 (58%) attendees and 15 (42%) nonattendees. Attendees reported equivalent or higher levels of comfort compared with nonattendees. Higher global competence was noted among attendees (odds ratio, 5.21; 95% confidence interval, 0.91-29.9; P = .06) after adjusting for presence of a local IBD specialist, number of IBD patients seen monthly (≤5 vs >5), and rotation through an IBD service. IBD 101, an introductory course for first-year GI trainees, was associated with increased comfort managing IBD with a durable benefit independent of individual access to IBD education. Continuation of this program will further enhance the IBD education of future GI fellows.

Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units

BackgroundKey performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI.MethodsIBD emergency admissions for 2018–2019 from Hospital...

Healthcare professional communication behaviours, skills, barriers, and enablers: Exploring the perspectives of people living with Inflammatory Bowel Disease.

This qualitative study conceptualised effective communication behaviours of healthcare professionals (gastroenterologists, surgeons, nurses, and general practitioners) and explored communication barriers and facilitators from the perspective of adults with Inflammatory Bowel Disease (IBD). Seventeen qualitative interviews were conducted with people living with IBD in the UK or USA (n = 17) and their spouses (n = 4). An inductive content analysis was firstly applied to participants' accounts to define which healthcare professionals' behaviours and skills were perceived as essential for effective communication. An inductive reflexive thematic analysis elucidated themes of perceived barriers and facilitators experienced when communicating with their IBD healthcare professionals. Thirty-three provider communication behaviours were grouped into nine healthcare professional skills. Five themes encompassed 11 barriers and facilitators: professionals' knowledge and behaviour, unequal power, patient navigation skills, time constraints and demand, and continuity and collaboration of care. For patients and some spouses, enhancing communication in IBD services means increasing patient, family, and health professional knowledge, encouraging collaborative partnership working, and promoting healthcare professional skills to communicate effectively within the reality of time restraints.

Clinical service delivery implications of the COVID-19 pandemic on people with Inflammatory bowel disease: a qualitative study

BackgroundDuring the COVID-19 pandemic, clinical services were severely disrupted, restricted, or withdrawn across the country. People living with Inflammatory Bowel Disease (IBD) – an auto-immune disorder for which medical treatment often results in immunosuppression, thus requiring regular monitoring—may have struggled to access clinical support. As part of a larger qualitative study, we investigated experiences of access to clinical services during the pandemic, and patient concerns about and preferences for services in the future.MethodsThis exploratory qualitative study used semi-structured interviews to explore participants’ experiences of clinical services across the UK during the pandemic. All data were collected remotely (March – May 2021) using online video-calling platforms or by telephone. Audio files were transcribed professionally and anonymised for analysis. Data were analysed using thematic analysis.ResultsOf the eight themes found across all data, four related specifically to accessing GP, local (district) hospital, and specialist (tertiary) referral services for IBD: 1) The Risk of Attending Hospital; 2) Missing Routine Monitoring or Treatment; 3) Accessing Care as Needed, and 4) Remote Access and The Future.ConclusionsOur findings support other studies reporting changes in use of health services, and concerns about future remote access methods. Maintenance of IBD services in some form is essential throughout crisis periods; newly diagnosed patients need additional support; future dependence on IBD services could be reduced through use of treatment / self-management plans. As the NHS digitalises it’s future services, the mode of appointment—remote (telephone, video call), or in-person – needs to be flexible and suit the patient.

A quality assessment of inflammatory bowel disease nursing care in Finland: a nationwide cross-sectional descriptive study

Objectives of the article Inflammatory bowel disease (IBD) nursing has been identified as a crucial component in the IBD service delivery. This article aims to provide a comprehensive overview of the state of IBD nursing care in Finland, and to identify areas that would benefit from further research. Materials and methods Tertiary IBD outpatient clinics nationwide were invited to participate in a cross-sectional descriptive study conducted using an electronic survey. The quality of IBD nursing services was assessed using the Nursing Care Quality in IBD (NCQ-IBD) evaluation tool. Results Of the 34 identified clinics, 27 participated (79.4%) in the study. The NCQ-IBD tool classifies the clinics in four categories, where A indicates the highest level of quality, and D the lowest. In this study, 26 clinics (96.3%) were classified at level C, and one clinic (3.7%) at level D. Nursing responsibilities in IBD management and informing the patients were at a high level of quality, whereas nursing research in IBD was at a low level. An IBD database (i.e. clinical IBD registry) was in use only in 10 clinics. Although training in the clinical aspects of IBD was readily available, there was a lack of training plans for IBD, and clinics seldom held an annual review of the IBD nursing activities and outcomes. There were very few clinics using structured indices and questionnaires, and only 16 clinics (59.3%) applied a written IBD protocol. Conclusion In the Finnish IBD nursing service, as measured with the NCQ-IBD tool, several areas for future improvement were identified.

56 Audit of assessment, prevalence, and treatment of osteoporosis for patients attending the inflammatory bowel disease Service in Mullingar Regional Hospital

Abstract Background Courses of steroids are common in patients with Inflammatory Bowel Disease (IBD) and are a risk factor for developing osteoporosis. Osteoporosis is a clinically silent entity and osteoporosis-related fractures are associated with chronic pain, disability, and impact quality of life. Screening of high-risk populations is the mainstay of fracture prevention. In this audit, we aimed to assess adherence to international guidelines for osteoporosis risk assessment and bone protection. Methods A retrospective audit was performed with a random sampling of 10% of the patients attending between October 2021 to October 2022 the IBD outpatient clinic in Mullingar Regional Hospital. Data included demographics, IBD diagnosis, FRAX tool components, FRAX score, bone health screening, DEXA results, and use of bone mineral protection. Clinical practice was compared against European Crohn’s and Colitis Organisation (ECCO) recommendations on bone protection in IBD. Results Of 150 charts reviewed, 39 charts were missing essential data and 8 had a diagnosis other than IBD. All 103 patients included in the analysis had received >3 months of systemic steroid use, of which 50 had a diagnosis of Crohn’s disease and 63 with ulcerative colitis. Two (2%) patients had a FRAX risk assessment for osteoporosis, and 22 (21%) had a DEXA ordered, of which 7 (7%) were by the IBD clinic. Two (2%) patients had a previous fragility fracture and 3 (3%) had been diagnosed with osteoporosis. Bone protection was used in 21 (20%) patients receiving steroids, including calcium and vitamin D supplementation (n = 19), and bisphosphonate (n = 2). Conclusion There are low rates of osteoporosis screening for IBD patients attending this service. There was inadequate data in the charts to calculate FRAX scores to assess osteoporosis prevalence. An intervention tool is currently being designed and the audit cycle will be completed with a repeat audit after implementation.

Outcomes of a Comprehensive Specialist Inflammatory Bowel Disease Nursing Service.

Inflammatory bowel disease (IBD) is best managed by a multidisciplinary team within a dedicated IBD service. IBD nurses play an important role within this team. We aimed to evaluate the contribution of our comprehensive outpatient IBD nursing service on patient outcomes, quality of care, and healthcare costs. We performed a retrospective review of all IBD nurse encounters with patients over a 12-month period from October 2020 to September 2021 at a tertiary IBD referral center. Each nurse encounter was classified with respect to its clinical context, activities, and outcomes. Descriptive statistics were used to characterize these encounters and an economic analysis was performed to estimate the cost savings to the hospital. A total of 2537 nurse encounters occurred with 682 patients; 41% of encounters were nurse-initiated contacts with patients and 34% were patient-initiated contacts with the nurse helpline (26% via email, 8% via telephone). Most encounters involved clinical assessments (66%), providing education, counseling or updates (47%), and reviewing investigation results (38%). A gastroenterologist was consulted for advice in 35% of contacts. An estimated 29 emergency department visits, 1925 outpatient clinic visits, and 137 general practitioner visits were avoided. After deducting costs incurred, a net estimated annual saving of up to AUD $570 838 was achieved. Nurses commonly facilitated faster access to investigations (29%), education provision (28%), delivery of biologic services (25%), and medication changes (19%). A comprehensive IBD nursing service is associated with improved patient outcomes and quality of care, and reduced healthcare costs. This study supports the expanding role of IBD nurses in a modern multidisciplinary IBD service and the need for greater funding and integration of IBD nurses into IBD services.

Opioid use and associated factors in 1676 patients with inflammatory bowel disease: a multicentre quality improvement project

ObjectiveDespite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the...

Stakeholder-identified barriers and enablers to ultrasound implementation in inflammatory bowel disease services in the UK: a qualitative interview study

ObjectivesThe study sought to explore and better understand the perceptions and experiences of stakeholders in relation to the use of ultrasound for the assessment of inflammatory bowel disease (IBD) in...

A survey of patient informational preferences when choosing between medical and surgical therapy for ulcerative colitis: a sub-study from the DISCUSS project.

People living with ulcerative colitis (UC) have two broad treatment avenues, namely medical or surgical therapy. The choice between these can depend on patient preference as well as the receipt of relevant information. The aim of this study was to define the informational needs of patients with UC. A postal survey was designed to capture respondent demographics, treatment experienced within the previous 12 months and informational preferences by rating a long list of items. It was delivered through two hospitals that provide tertiary inflammatory bowel disease services. Descriptive analyses were performed to describe demographics and experiences. Principal component analysis was carried out using a varimax rotation to investigate informational needs. A total of 101 responses were returned (20.1% response rate). The median age of respondents was 45 years and the median time since diagnosis was 10 years. Control preferences skewed towards shared (42.6%) or patient-led but clinician-informed (35.6%). Decision regret was low for the population (median 12.5/100, range 0-100). Key informational needs related to medical therapy were benefits and risks of long-term therapy, burden of hospital attendance, reproductive health, need for steroid treatment and impact on personal life. For surgery, these were stoma information, effect on daily life, effect on sexual and reproductive health, risks and benefits and disruption of life due to surgery. This study has identified key areas for discussion when counselling patients about treatment decisions around medical therapy and surgery for UC.