Inflammatory Bowel Disease Team Research Articles

A120 A HUMAN-CENTERED DESIGN APPROACH TO THE DEVELOPMENT OF A VACCINE IMPLEMENTATION STRATEGY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Vaccination uptake amongst patients with inflammatory bowel disease (IBD) remains suboptimal. Our previous study assessed perceived barriers and solutions related to implementation of evidence-based guidelines for vaccine preventable illness (VPI). Barriers included limited time, lack of access to a family physician, and incomplete understandings of coverage/access to vaccines. Aims The aim of this study was to use human-centered design (HCD) to design a vaccine implementation program in patients with IBD. Methods The HCD approach consisted of multiple phases. Phase 1 (discovery and define) consisted of semi-structured interviews of healthcare providers. Phase 1 also included the development of a context-specific patient journey map of the processes involved in accessing vaccines. This map was developed in collaboration with a multidisciplinary IBD team. Phase 2 involved identifying common barriers and facilitators through thematic analysis and journey mapping. In Phase 3, these analyses were used to design an implementation strategy for evidence-based management of VPI in the local health system context. Results Twelve interviews (including 11 gastroenterologists and one IBD nurse practicing in Nova Scotia and New Brunswick) were conducted. Mean participant age was 45.1 years, with 63.6% identifying practice in an urban/academic setting compared to a rural/community setting (36.4%). Lack of access to a family physician, limited time, vaccine hesitancy, and incomplete understanding of coverage/access to vaccines were among the barriers identified. Using facilitator themes as well as the journey mapping process, a proposal for an early implementation strategy prototype was designed. Prototype development involved collaborative partnership with a third-party patient support program to overcome various barriers identified in our surveys. Conclusions Barriers to implementation of evidence-based guidelines for management of VPI are well documented. The use of HCD to design an effective implementation strategy that is sensitive to the local healthcare context holds potential to increase access to and uptake of high quality, evidence-based VPI management. In future studies, the implementation-effectiveness of the implementation strategy (model prototype) will be evaluated and compared to standard of care. Funding Agencies None

A Real-World Prospective Cohort Study of Patients With Newly Diagnosed Crohn's Disease Treated by a Multidisciplinary Team: 1-Year Outcomes.

Real-world data on outcomes of patients with newly diagnosed Crohn's disease (ndCD) is limited. We aimed to assess the achievement of corticosteroid-free clinical remission (CS-free CR) and other therapeutic targets 1 year after diagnosis in a cohort of patients with ndCD treated by a multidisciplinary team (MDT). A prospective observational cohort study was conducted on consecutive treatment-naïve adults with ndCD. Patients received management at the treating physician's discretion, along with a tailored nutritional plan provided by an inflammatory bowel disease (IBD)-oriented dietitian. Patients were guided and educated by an IBD nurse, with flexible communication access to the IBD team. Therapeutic targets were assessed at 1 year. Multivariable logistic regression was used to evaluate predictors of CS-free CR. Seventy-six patients (50% female) with a median age of 27 (22-39) years were eligible. Over 75% of patients were assessed by IBD-oriented dietitians and the IBD nurse. Within a median of 4.3 (2.5-6.7) months from diagnosis 60.5% initiated biologics (96% anti- tumor necrosis factor). Dietary intervention was applied to 77.6% of the cohort, either monotherapy (33.9%) or add-on (66.1%). At 1 year, 64.5% of patients achieved sustained CS-free CR, 56.6% biochemical remission, 55.8% endoscopic response, 44.2% endoscopic remission, 30.8% deep remission, and in 39.5% there was an improvement in health-related quality of life (HRQoL). Predictors for CS-free CR were uncomplicated phenotype (B1/P0), lower body mass index, and lower patient-reported outcome 2 scores at diagnosis. In a real-world setting at a tertiary medical center, a cohort of ndCD patients treated by an MDT resulted in favorable 1-year outcomes. Over 60% achieved CS-free CR, along with significant improvements in biomarkers and HRQoL.

N30 Understanding Inflammatory Bowel Disease Emergency Department Admissions in a Tertiary Referral Inflammatory Bowel Disease Centre in England: A quality Improvement project

Abstract Background In February and March 2022, the emergency department (ED) affiliated to a tertiary referral inflammatory bowel disease (IBD) centre in England undertook an audit of ED attendances as part of an IBD-related admission quality improvement project (QUIP). Quality standards recommend review within 5 days of a flare. Patients presenting to ED may reflect failure of urgent GP access or to the IBD advice line a marker of poor-quality care. Methods Patients with suspected IBD presenting to ED during the audit period were identified the initial results generated further questions for the IBD team. A excel data base was created and the electronic patient record for each patient was retrospectively reviewed. Data relating to previous contact with the IBD team, how patients were referred to ED and confirmation of an IBD diagnosis was collected. Descriptive statistical analysis was used to present the data. Results There were N=48 ED attendances with a suspected diagnosis of IBD between February and March 2022. From the N=48 attendances from n=41 patients, n=29 (60.42%) admissions occurred for these patients. n=19 (39.58%) episodes resulted in discharge with five of these being self-discharges. of the n=41 patients n=4(9.76%) did not have a diagnosis of IBD n=1 (2.44%) with a diagnosis of IBD was not known to the IBD interdisciplinary team. Additionally, n=2 (4.88%) were new patients neither were known to the IBD team and n=2 (4.88%) were suspect diagnosis. multiple attendances occurred and n=1 (2.44%) patient attended four times and n=4 (9.76%) patients attended twice each meaning n=5 (12.2%) of the patients were responsible for n=12 (25%) of attendances. Of the original N=48 attendances, n=32 (66.67%) attendances occurred with no contact to the IBD advice line and n=19 (46.34%) of the n=41 patients responsible for these attendances. The outcomes are summarised in Table 1. Conclusion The original QUIP data was incomplete, and the actual IBD ED attendance rate was 66.66% of the original quoted figure, raising the importance of data cleaning and quality in QUIP. Focusing in on the 32 attendances where patients did not call the advice line, improvements to the messaging that IBD advice line service is available has become a priority as has utilising advanced nurse practitioner and specialist registrar skills to support patients therefore avoiding some of this ED attendance in the future. So far, adding advice line details to clinic letters, advertising in clinic, and setting up rapid access flare clinic led by Advanced Nurse Practitioners from the IBD Nursing team have been implemented. There are plans to review the attendance at IBD patients in ED in the same period in 2023.

P030 Assessing dietetic interventions in inflammatory bowel disease patients

Abstract Background Nutrition can play a role in the management of inflammatory bowel disease (IBD) as well as general nutritional status, however there are many types of dietetic interventions depending on the circumstances. We decided to survey some of the nutrition interventions that IBD patients may be provided with to obtain a general picture of how helpful this is to patients, as well as the effectiveness of having a specific IBD dietetic post. Methods The inclusion criteria were patients with a diagnosis of IBD, reviewed by the IBD dietitian and patients had to be under the IBD team at Whipps Cross Hospital. Patients were asked if they consented to providing their email address for the anonymous survey link to be sent to. The survey was then emailed to 50 IBD patients. Nine questions were asked on the survey and an internet survey provider was used. Results The total response rate was 32% to the survey. The mean age was about 40 years old. 40% of patients were male with the remainder being female. 58% of the patients had Crohn’s disease with the remainder having UC. 100% of patients felt the dietitian involved them in decision making. The results of the following dietetic interventions are only where applicable to patients: 100% of patients rated nutrition support care (including exclusive enteral nutrition for Crohn’s disease) as excellent or good. 100% of patients rated specific IBD dietary advice as excellent or good. 100% of patients rated functional symptoms or irritable bowel syndrome advice as excellent or good. 100% of patients rated artificial nutrition advice as good. 81% of patients felt advice improved symptoms and nutritional state with 13% being unsure. 81% of patients felt advice improved quality of life with 13% being unsure. 81% of patients felt cultural, lifestyle and language needs were considered with 13% being unsure. 100% of patients felt having access to a dietitian was helpful. Conclusion All patients felt that the specific types of dietary care provided were excellent or good, with the majority of patients responding that advice improved symptoms, improved quality of life and that cultural and lifestyle needs were taken into account. All patients found it supportive to have a dietitian as part of the IBD multidisciplinary team. It would be useful in the future to further assess these types of dietetic care, such as exclusive enteral nutrition for Crohn’s disease. These findings support the best practice guidelines for having a dietetic post as part of the IBD team.

Clinical outcomes amongst elderly patients with inflammatory bowel disease.

Inflammatory bowel disease (IBD) affects a growing cohort of elderly patients. Our aim was to compare the quality of care received by elderly patients with IBD with a nonelderly adult IBD population using clinical markers including steroid-free clinical remission. Retrospective audit of all consecutive patients attending a specialist IBD centre over a 1-year period aged >60 (elderly cohort [EC]) and 50 consecutive patients aged 30-45 years (control cohort [CC]). A follow-up survey was completed assessing current symptoms and perceptions of care. One hundred thirty-nine patients were evaluated (89 EC, 50 CC). Steroid-free clinical remission was observed less commonly in the EC (58, 64%) compared with the CC (40, 80%) (P < 0.05). Biologics such as infliximab (15% EC vs 36% CC; P < 0.01) and adalimumab (14% EC vs 30% CC; P = 0.02) were used less frequently in the EC, whilst vedolizumab (6% EC vs 6% CC; P = 1) and ustekinumab (3% EC vs 2% CC; P = 1) were used at a similar frequency. Patients in the EC were less likely to have specialist IBD nursing contact (P < 0.01), smoking screening (P < 0.011) or influenza vaccinations (P < 0.006). IBD nurse contact was associated with significantly greater provision of the preventative care measures. Elderly patients with IBD were less likely to experience steroid-free clinical remission or be prescribed biologics. Elderly patients were less likely to receive education with respect to preventative medicine. The models of care for the elderly need re-evaluation and greater incorporation with the multidisciplinary IBD team.

Dietary management of adults with IBD - the emerging role of dietary therapy.

Historically, dietitians played a minor part in the management of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Patients were commonly referred for consequences of uncontrolled disease, such as malnutrition and bowel obstruction risk. Today, dietitians are fundamental members of the multidisciplinary IBD team, from educating on the role of diet at diagnosis and throughout the lifespan of a patient with IBD to guiding primary induction therapy. This aspect is reflected in published guidelines for IBD management, which previously placed diet as only a minor factor, but now have diet-specific publications. This Review describes a four-step approach in a dietitian's assessment and management of diet in patients with IBD: (1) identifying and correcting nutritional gaps and dietary imbalances; (2) considering diet to treat active disease with the use of exclusive enteral nutrition (EEN) or emerging diets that could replace EEN; (3) using therapeutic diets to control existing complications of IBD, such as reduced fibre to prevent bowel obstruction in stricturing disease or a fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet to manage co-existing functional gut symptoms; and (4) considering the role of diet in preventing IBD development in high-risk populations.

N08 The influence of the Covid-19 epidemic on access to medical advice for children with Inflammatory Bowel Disease (IBD), based on patients from The Children’s Memorial Health Institute, Warsaw (IPCZD)

BackgroundCOVID -19 significantly affected all levels of medical care as well as access to medical care for children with Inflammatory Bowel Diseases (IBD).The purpose of the study was to investigate how the Covid-19 epidemic influenced on the access to medical care for children with IBD, on the quality of medical care during this period and on the health of young patients.MethodsThe analysis was based on the results of the questionnaire containing 15 questions addressed to the parents of children with IBD. The questions concerned mainly access to GP consultations and gastroenterology consultations, but also access to medicines and parents’ concerns about the health of children during the pandemic.Since December 2020, 150 questionnaires have been sent to parents of children with IBD. 72 completed questionnaires were returned and 60 of them were included into the analysis (12 were excluded due to lack of complete data). The T-Student test was used for statistical analysis.ResultsOnly 5 % of respondents (n=3) stated that the pandemic had no impact on access to a GP, as many as 83% (n = 50) indicated that the epidemic made access to primary care physicians very difficult.Changes in access to health care during the Covid-19 epidemic caused anxiety about further treatment of the child in 96.7% (n = 58, p<0,05) of the surveyed parents.In The Children’s Memorial Health Institute due to the limitations of visits related to the development of the pandemic, telemedicine was introduced on a large scale. Due to the easy access to medical telepaths and the resulting, if necessary, outpatient visits, the respondents assessed the access to medical consultations of doctors from the IBD team in IPCZD as much better than before the pandemic 58% (n = 35, p<0,05) or no changes compared to the time before the pandemic 42% (n = 25). 90% (n=54) of the surveyed parents indicated that they would also like to use telemedicine after the epidemic as an alternative to some hospital visits.Statistical analysis also showed a correlation between difficulties with access to specialized medications during a pandemic and the occurrence of an exacerbation of the disease in a child during that period.Out of the 40 (67%) group of parents who showed difficulties in purchasing medicines for their children in the survey, as many as 75% (n = 30, p <0.05) reported exacerbation of the disease during the epidemic.ConclusionBased on the above results, we concluded that the pandemic had a major impact on access to medical care as well as on access to specialized medications. In The Children’s Memorial Health Institute, thanks to the development of telemedicine, access to specialist care in the IBD team has not changed.

P397 Can upskilling pharmacy technicians support a robust and cost-effective Inflammatory Bowel Disease patient review process? A single-centre prospective study

Abstract Background Immunomodulators are key to the management of Inflammatory bowel disease (IBD). To ensure safety and efficacy, UK guidance recommend immunomodulator review. At University Hospitals Sussex (UHS), reviews are completed by a multi-disciplinary team (MDT), with specialised IBD pharmacists and nurses leading on autonomous blood monitoring and symptom review (figure 1). This workload puts considerable strain on the UHS IBD team. Upskilling and task shifting is recognised as legitimate strategy for service enhancement, care access, cost effectiveness and sustainability plus ensures team flexibility, boosted morale and career progression. The UHS IBD team includes a highly motivated pharmacy technician (PT). In the UK, PT are registered non-prescribing healthcare professionals, but training does not include autonomous blood monitoring and symptom review. Methods To ensure competency of autonomous blood monitoring and symptom review, a training package was developed and was approved by UHS Medicines Governance Group. Once accredited, PT prospectively recorded blood monitoring and symptom review activity over, 10-weeks (figure 2 and, 3) and referrals completed (figure 4). Results The training package was completed in, 10 weeks. Over, 10 weeks, PT completed, 699 distinct monitoring activities, with, 57 (8%) needing referral to the specialised pharmacist. The highest proportion of workload was observed in the IBD infusion clinic (314, 45%), followed by thiopurine monitoring (250, 36%) and then ‘others’ (135, 19%). ‘Others’ were essential IBD activities including faecal calprotectin levels (FCPL), pre-initiation tests (e.g. thiopurine methyltransferase levels (TPMT), viral screening, t-spots) and medication levels to optimise therapy. All referrals to the specialised pharmacist were appropriate as needed action by a prescribing professional. In addition, PT contributed substantially to data collection for virtual biologic clinic (VBIC) reviews;, 32 patients. Feedback has been overwhelmingly positive from all effected stakeholders (PT, IBD pharmacy and nursing team and gastroenterologists). Conclusion Identifying appropriate tasks and upskilling the IBD PT has enabled a more cost-effective and efficient use of IBD workflow, care standardisation, team robustness and staff morale. Approved training and support are required to enable upskilling and continued service safety and we recommend that skills are recognised locally and nationally.

P025 A review of the newly implemented Inflammatory Bowel Disease dietetic service

Abstract Background Nutrition plays an important role in the onset and later the management of inflammatory bowel disease (IBD). Patients are becoming progressively interested in non-pharmacological methods of managing IBD and the dietary advice around this. It is reported that only 7% of services have enough dietitians to meet the IBD Standards recommendation. A year after the implementation of a new dietetic post at Whipps Cross Hospital, it was decided to review the effectiveness of this post for patients with a survey. Methods The inclusion criteria were patients with a diagnosis of IBD, reviewed at least twice by the IBD dietitian and patients who are under the IBD team at Whipps Cross Hospital. Patients were telephoned and asked if they consented to providing their email address for the anonymous survey link to be sent to. The survey was emailed to 40 patients. Six questions were asked on the survey, the survey provider was Survey Monkey. Results The final cohort included a 53% response rate to the survey. Age range was 18–64 years old. 95% of patients felt their consultation time was long enough. 95% of patients thought they had sufficient dietetic contact. 95% of patients felt the dietitian involved them in decision making. 67% of patients thought nutrition input improved their health/quality of life, with 29% being unsure. 100% thought having access to an IBD dietitian was useful. 71% of patients rated their dietetic care as excellent and 29% rated it as good. Conclusion The response from the majority of IBD patients was that nutrition input was helpful; with all patients finding the care provided by the dietitian was either good or excellent. All patients found it supportive to have dietetic access as part of a multidisciplinary approach to their IBD care. These findings support the best practice guidelines for having a dietitian post as part of the IBD team.

P415 Improving food-related quality of life in Inflammatory Bowel Disease with a novel web-based intervention: a randomised controlled feasibility trial

Abstract Background Food-related quality of life (FR-QoL) refers to the psychosocial aspects and pleasure derived from food, eating and drinking. Impaired FR-QoL is prevalent in inflammatory bowel disease (IBD) and is associated with reduced intakes of fibre and certain micronutrients. Patient and health professional focus groups identified the need for web-based support and education on food in IBD, which was subsequently developed through experience-based co-design. The aim of this study was to establish the feasibility of a randomised controlled trial (RCT) investigating the effectiveness of the web-based intervention compared to usual care on FR-QoL in people with newly diagnosed IBD. Methods A randomised controlled feasibility trial was conducted in adults with Crohn’s disease or ulcerative colitis diagnosed in the preceding, 12 months. Patients with active and inactive IBD experiencing impaired FR-QoL (≤90 scored on the validated FR-QoL-29 questionnaire) were recruited. Participants were delivered usual care by their IBD team and were also randomised to either access to the web-based intervention (containing information and patient and clinician videos on various IBD-specific food and nutrition considerations) or no access to the website for, 12 weeks. Questionnaires were completed at baseline and end of trial to assess FR-QoL (FR-QoL-29), health-related quality of life (UK IBDQ), IBD distress (IBD Distress Scale) and anxiety and depression (HADS). Google Analytics was used to investigate usage of the web-based intervention. Results In total, 50 participants (ITT population) were recruited (81 screened), 30 randomised to the web-based intervention and, 20 to usual care, with, 48 completing the trial (PP population). In the ITT analysis, a greater increase in FR-QoL was observed in the web-based intervention (+11.7 SD, 18.2) than usual care group (+1.4 SD, 20.4, P=0.057), whilst IBD distress reduced in the web-based intervention (-6.8 SD, 26.6) and increased in the usual care group (+8.3 SD, 25.5, P=0.052). Participants in the web-based intervention group logged into the website an average of, 4.2 (SD, 2.9) times, and spent an average of, 13 minutes, 41 seconds (SD, 15 minutes, 1 second) on the website per visit. The most frequently accessed content covered dietary management of specific gut symptoms (accessed by, 52% of participants). In qualitative interviews the participants reported the intervention to be clear, user friendly, easy to navigate, and a good source of educational information. Conclusion This feasibility study demonstrates that a RCT of a web-based intervention is feasible and potentially effective in improving FR-QoL in IBD. An adequately powered RCT investigating the effectiveness of this intervention in IBD is feasible and now warranted.

P357 Monitoring of Thiopurines and Methotrexate in Inflammatory Bowel Disease: Are we Monitoring Too Frequently? A Cross Sectional Study

Abstract Background The use of immunosuppressive medications such as thiopurines and methotrexate (MET) are commonly employed in inflammatory bowel disease (IBD) to control symptoms and maintain remission. The British Society of Gastroenterology recommends three monthly full blood count (FBC) and liver function tests (LFT) to monitor for myelotoxicity and hepatotoxicity after being established on therapy. However, the quality of evidence for this is low. Due to the high burden of blood tests and patients becoming increasingly apprehensive to attend hospital or their general practice surgery in the midst of a pandemic, we aimed to investigate (1) the feasibility to adhere to these recommendations and (2) the frequency of abnormal blood test when recommendations are adhered. Methods We performed a, 12-month cross sectional study from July, 2017 to July, 2018 of patients established on azathioprine (AZA), 6-mercaptopurine (6-MP), or MET. The timeline was split into four windows of three months each. A patient was removed from the study if they reached any one of these six end points: no FBC or LFT checked within a window, new abnormal LFT, white cell count (WCC) less than, 3.5, change in medication, change in dosage, and medication stopped. Results As of, 2019, 4327 patients were under the care of our specialist IBD team with, 1081 on active therapy. We identified, 205 patients who were established on these agents (AZA = 156, 6-MP = 41, MET = 8) within the determined study period. A total number of, 96 patients reached an end point during this period. For our first objective, a patient was deemed to have been monitored if FBC and LFT was checked at least once during a window., 26% (54/212) of patients were removed from the study as they did not fulfil this criteria. Of the remaining, 41 patients who reached an end point, 14 were due to a new abnormal LFT result (AZA = 8, 6-MP = 6, MET = 0) and, 5 due to a WCC less than, 3.5 (AZA = 4, 6-MP = 1, MET =0). Excluding non-adherent patients, our study revealed only, 12% (19/158) of patients had to discontinue therapy due to an abnormal blood test. Conclusion Achieving an adherence of, 74% was possible with a team of dedicated IBD specialist nurses and doctors in a tertiary centre. Whilst there is still much room for improvement, this may be difficult to replicate in smaller centres with more limited resources. Despite the small sample size, our finding of only, 12% of abnormal blood test is consistent with similar studies done by Fournier et.al in, 2010 and Chaparro et.al in, 2013. This would certainly pose the question if we can consider monitoring less frequently.

N18 Introduction of inflammatory bowel disease specialized dietitian and nutritional status in a multidisciplinary IBD team

Abstract Background Qualitative inflammatory bowel disease (IBD) care is marked by a multidisciplinary approach including physicians, nurses, psychologists and dietitians. Specialist IBD dietitians can address the specific needs of patients with IBD, with an emphasis on nutritional status, disease activity, and functional symptoms. We wanted to obtain a snapshot of the IBD population referred to the dietitian at our IBD clinic. Methods Since February 2021, two specialist IBD dietitians were hired at the multidisciplinary IBD-team of our tertiary referral centre. Data from all IBD patients seen by the IBD-dietitians were prospectively collected. Patients with IBD were referred to the IBD dietitians for dietary advice concerning optimization of nutritional status, modulation of diet-induced abdominal symptoms, and IBD-related problems (e.g. high output stoma, obstruction, enteral or parenteral nutrition). Malnutrition as reason for referral was defined as an abnormal body mass index (BMI &amp;lt;18.5 or &amp;gt;25 kg/m²). Results From 1 February 2021 until 16 November 2021, 219 IBD patients (58.4% women, median age 38 years, 127 Crohn’s disease, 92 ulcerative colitis) were seen by the IBD-dietitians. Patient characteristics are described in table 1. A total of 303 contacts were registered, including 82% in-hospital consultations (16% in-patient clinic, 66% outpatient clinic) and 18% remote consultations (via telephone or email). The median BMI at first consultation was 23.49 kg/m2. In this cohort, 46.6% of IBD patients had a normal BMI, 37% were obese or overweight, and 13.2% has underweight. Males had a significantly higher BMI than females (BMI 24.5 vs 22.5 kg/m2, p-value 0.048). The main reasons for referral were IBD-related symptoms or disease activity (46.6%), malnutrition (26%), functional symptoms (16.4%), and patient’s interest in receiving more information on diet (9%). Of note, none of the patients were being treated with enteral nutrition at time of referral, and only 5 patients were being treated with parenteral nutrition. Most patients received dietary advice (92%) and only 1 patient was started with enteral nutrition. Conclusion The introduction of IBD-dietitians in our multidisciplinary IBD care program has allowed IBD-patients with or without malnutrition, to be assessed by a specialist IBD dietitian who can provide appropriate dietary advice. Of note was that despite an already expert IBD center with a multidisciplinary team in place, the prevalence of malnutrition in this selected IBD cohort was very high. Nevertheless, IBD disease activity and IBD-related symptoms were the main reason for referral to the IBD-dietitian, reflecting the need for tailored nutritional advice complementary to medical or surgical treatment.

P124 Views of patients with Inflammatory Bowel Disease on their care during COVID-19 pandemic

BackgroundPatients with inflammatory bowel disease (IBD) have experienced changes to their usual management during the COVID-19 pandemic. We organised an anonymous survey to obtain their perspective on what impact COVID-19 had on their disease and care.Methods115 patients with IBD followed up in our clinics between August and October 2021 were sent a questionnaire with multiple choice questions as well as free comment sections which enabled patients to develop their answers in more detail. 53 patients returned the questionnaire until now.ResultsThere were no statistically significant differences in descriptive characteristics – 52.8% patients were men, mean age was 53.1 years (range 18–85). 52.8% patients had Crohn’s disease. Overall, 38/53 were satisfied with services provided during the pandemic and similarly, 39/53 patients reported that they were happy or very happy with the use of virtual clinics. Overall, it was surprising that 56.6% patients felt that the pandemic had no impact on their disease. Nevertheless, 20.8% experienced delay in clinic appointments, 18.9% felt uncertainty about their diagnosis and 15.1% felt programmed investigations were postponed. 41 patients had a flare and 24/41 used our Helpline to obtain advice. Only one patient reported negative experience. In the free comment section, most messages were appraising the IBD team and Helpline as a useful way of keeping in touch and receiving advice. Patient 45 wrote: “I contact the team via email and am always responded to quickly.”Most patients had positive views about virtual clinics, finding them easy and straightforward (31/53), with the advantage of not having to commute to hospital (28/53) and receiving good communication (26/53). 7/53 described virtual clinics as negative, rushed (8/53) and found it difficult to communicate (2/53). In the free comment section, many patients felt that “… there is no real substitute for a face-to-face consultation.” (patient 34) Nevertheless, in the future, 28.3% patients would like to continue with face-to-face appointments, 17.0% would be happy to continue with virtual clinics. The rest was happy with both options.27/53 patients were able to have regular blood tests with their GP, the rest used hospital or associated services. 26/53 obtained their new medications directly from hospital, 7/53 were able to contact their GP. 18 patients did not require any new medications and continued with their regular prescription.All patients have received vaccination against COVID-19.ConclusionMost of our patients were happy with the services provided during COVID-19 pandemic and felt that the pandemic had not had a significant impact on their disease.(Note: this project is ongoing and will continue in November 21).

P129 IBD care in the UK: A comprehensive, novel service assessment with feedback from 10,222 patients and 166 NHS organisations to inform a vision for quality improvement

Abstract Background The IBD Benchmarking Tool, comprising an online Service Self-Assessment and Patient Survey, has provided a unique and comprehensive picture of Inflammatory Bowel Disease (IBD) care across the UK. The aim was to evaluate current local service performance to facilitate future quality improvement. Methods The IBD Patient Survey (PS) ran from July to November 2019 and the Service Self-Assessment (SSA) from October 2019 to January 2020. Detailed views were collected of the quality of IBD care from patient and clinician perspectives, measured against the UK IBD Standards 2019.1 The IBD UK National Report will be published in April 2021. Results 10,222 patients completed the PS. 89% (9,100/10,222) had found it hard to cope with having Crohn’s or Colitis over the previous year. 72% (6,954/9,640) rated the quality of their care as excellent, very good or good and 28% (2,686/9,640) rated the quality of their care as fair or poor. The top three factors that predicted how highly people with IBD rated their quality of care were: feeling supported by a team of specialists; having regular reviews; and discussing wider life goals and priorities, as part of planning their care. 26% (535/2,089) had waited more than a year for their diagnosis. 41% (849/2,087) had visited Accident &amp; Emergency at least once before being diagnosed. 32% (656/2,057) were not offered any information about their condition when diagnosed. 91% (8,284/9,099) did not have a personalised care plan. Over the previous 12 months, 70% (6,732/9,574) had one or more flares and 72% (1,622/2,250) of inpatient admissions were unplanned. A key finding from the SSA (166 centres: 134 adult, 32 paediatric) was that no adult IBD services reported meeting the IBD Standards’ recommendation for whole time equivalent (WTE) staffing across the IBD team. Where services reported meeting the WTE for IBD nurse specialists, patients were more likely to rate the quality of their care highly and to have regular clinical review of their Crohn’s or Colitis. Conclusion The results highlight four key areas for change: improvements in diagnosis and information provision; personalised care and support for self-management; faster access to specialist advice and treatment; and effective multidisciplinary team (MDT) working. The Report sets out recommendations for action in each of these areas. To our knowledge, this is the first time that healthcare professionals and patients have assessed care against a common set of standards. The IBD Benchmarking Tool provides location-matched service performance and patient experience as an exemplar for others to follow. Reference

Crohn’s Colitis Care (CCCare): bespoke cloud-based clinical management software for inflammatory bowel disease

Background Adherence to evidence-based management is variable in inflammatory bowel disease (IBD), which leads to worse patient outcomes and higher healthcare utilization. Solutions include electronic systems to enhance care, but these have often been limited by lack of clinician design input, poor usability, and low perceived value. A cloud-based IBD-specific clinical management software – ‘Crohn’s Colitis Care’ (CCCare) was developed by Australia and New Zealand Inflammatory Bowel Disease Consortium clinicians and software developers to improve this. Methods CCCare captures patient-reported disease activity and medical assessment, medication monitoring, cancer screening, preventative health, and facilitates communication with the IBD team and referring doctor. De-identified longitudinal data are stored separately in a clinical quality registry for research. CCCare was tested for feasibility and usability in routine clinical settings at two large Australian hospitals. Users’ experience was evaluated with System Usability Scale (SUS). Value to clinicians and patients was assessed by qualitative feedback. Security was assessed by penetration testing. Results Users (n = 13; doctors, nurses, patients) reported good usability and learnability (mean SUS score 75 (range 50–95), sub-scores were 77 (50–94) and 68 (38–100), respectively). Patients reported better communication with clinical team and greater ability to track disease. Clinicians highlighted structured management plans, medication adherence, and centralised data repository as positive features. Penetration testing was passed successfully. Conclusions Initial evaluation demonstrates CCCare is usable, secure, and valued in clinical use. It is designed to measure outcomes of clinical care, including efficacy, quality, cost, and complications for individuals, and to audit these at hospital and national level.

Life in lockdown: experiences of patients with IBD during COVID-19

ObjectiveCOVID-19 has disrupted the normal way of life in the UK, but for some patients with inflammatory bowel disease (IBD), the impact of this unprecedented global emergency was far greater....

COVID-19-related health anxieties and impact of specific interventions in patients with inflammatory bowel disease in the UK

ObjectiveHealth-related concerns brought on by the COVID-19 pandemic and the impact of specific local and national interventions have not been explored in patients with inflammatory bowel disease (IBD) in the...

Absence of COVID-19 Infection in Patients Accessing IBD Unit at Humanitas, Milan: Implications for Postlockdown Measures.

INTRODUCTION:The risk of coronavirus disease-19 infection for healthcare professionals and patients in hospitals remains unclear.METHODS:We investigated whether precautions adopted in our inflammatory bowel disease (IBD) unit have minimized the risks of infection for all patients accessing our facilities in a 1-month period by assessing the rate of coronavirus disease-19 infection in the follow-up period.RESULTS:Three hundred-twenty patients with IBD were included. None were infected from severe acute respiratory syndrome-coronavirus 2 in the follow-up period. None of the IBD team members were infected.DISCUSSION:Neither pharmacological immunosuppression nor access to the hospital seem to be risk factors for infection in patients with IBD.

P197 A snap-shot survey of IBD patients’ at a tertiary centre: a focus on knowledge and willingness to self-manage

Abstract Background Good quality Care in inflammatory bowel disease (IBD) includes the provision of patient-relevant information.1 Data on the level of patient understanding is lacking. We studied patients’ understanding of their IBD condition. Methods The IBD team and patient representatives devised a 16-item questionnaire that collected data on baseline demographics and disease-specific characteristics. Answers denoting understanding were scored positively. A sum (Q-sum) of the individual question scores was expressed as median (range). Results 150 patients were surveyed (49% male). Thirty-nine per cent had ulcerative colitis, 51% Crohn’s Disease and 10% IBD-unclassified. There were: 39 aged &amp;lt;30, 94 aged 30–60, and 15≥60. The median (range) Qsum was 9 (1–16). Twelve per cent of patients had a Qsum of ³13. The Qsum of patients &amp;lt; 60 years old was 10 (2–16) compared with 7 (1–13) of the ≥60 age group (p = 0.02). Sixty-two per cent of the younger and 60% of the older group perceived themselves as well informed (p = 0.9). The Qsum scores were 12 (2–14), 10 (2–16) and 8.5 (3–14) for patients with disease duration of ≤1 year, 2–15 and ≥15 years respectively (p &amp;lt; 0.05). There was no difference in scores according to disease and medication type. 96% of patients in the &amp;lt;60 age group were willing to access online information compared with 60% in the ≥60 age group (p &amp;lt; 0.01). Younger patients were more confident in recognising symptoms of a flare [86%] compared with those aged ≥60 [60%] (p = 0.01), and were also more likely to understand how their condition may progress compared with older patients (66% vs. 40%, p &amp;lt; 0.05). Among patients &amp;lt;60 years only 14% of males and 26% of females (p = 0.08) reported having enough information on fertility. Sixty-six per cent of patients on biologic drugs and 53% on non-biologic drugs considered themselves well informed (p = 0.12). Forty-six per cent of the non-biologics cohort also reported low levels of knowledge on self-management of mild flares. Seventy-six per cent of the biologics group and 87% of the non-biologics group expressed willingness for information on self-management (p = 0.1). Conclusion Older patients are less well informed, less confident in recognising symptoms of a flare, and less likely to access on-line resources. The level of knowledge inversely correlated with disease duration. This may reflect the heightened recent awareness on the inclusion of patient education in clinical care and availability of resources. There is an interest in receiving information on self-management of mild flares. Education sessions should be personalised according to patient characteristics and objective measures such as PAM score (Insignia Health), implemented to show benefits. Reference

Implementing IBD Registry audit tools in a nurse-led inflammatory bowel disease service at a district general hospital

Inflammatory bowel disease (IBD) is a chronic condition with no known cure. Continual auditing of patients is an important part of developing and refining therapies, including biologics, for inducing and maintaining remission. Between 2006 and 2016, the IBD National Audit gathered data that showed how services should improve standards to meet patient needs. This was followed by the IBD Registry, a multi-agency initiative to enable local teams to electronically record clinical data at the point of care to benefit patients, clinicians, commissioners and managers. The service integrates with existing hospital systems and uses a patient management system (PMS), a web tool for real-time data collection and a data visualisation tool for biologics. As of 2017, there were 99 participating sites, with data from 31 614 patients. A district general hospital successfully implemented the registry auditing tools, despite initial administrative challenges; the IBD team have used the data to demonstrate the value of the specialist nursing service, expanding it by recruiting another 0.6 whole-time equivalent nurse. The PMS offered more robust tools for monitoring complex, high-cost treatments, such as biologics.