Leanne Raven, Crohn’s and Colitis Australia.

Four years on from the launch of Australia’s IBD National Action Plan, patients still face issues such as access to multidisciplinary care and tests and treatments for the disease, according to patient advocates.

A national meeting convened in Melbourne on 3 November by Crohn’s and Colitis Australia (CCA) and AbbVie Australia heard there was a need to further action to implement the recommendation in the IBD National Action Plan that was developed in 2019.

“The vision for the Government’s IBD National Action Plan was for all Australians living with inflammatory bowel disease to have access to high quality, integrated care. Whilst we have made advances in a number of areas, there is still significant work to be done,” said Leanne Raven, CEO of Crohn’s and Colitis Australia.

Ms Raven, who contributed to the Action Plan, said another recent global IBD report had highlighted ongoing unmet areas of need for people with IBD that include multidisciplinary team care and patient-centric care.

“IBD is one of a number of complex chronic diseases which require specialist care and have a significant impact on the health system. Effective solutions with the potential to enhance care pathways and improve patients’ quality of life exist, but achieving this requires a dedicated commitment to system change,” said Ms Raven

Led by a gastroenterologist, the MDT would include specialist nurses, who ensure continuity of care, as well as dieticians, colorectal surgeons, psychologists, pharmacists and administration staff “to help manage the often complex treatment and care pathways required for the effective management of IBD,” she said

“Despite emphasising its significance in the IBD National Strategic Action Plan three years ago, the availability of a skilled and accessible multidisciplinary workforce who can care for the many facets of IBD remains a challenge,” said Ms Raven.

“The pandemic has resulted in significant workforce attrition and difficulty recruiting nursing staff for IBD programs,” she noted in the recent report.

Her call was endorsed by Associate Professor Greg Moore, Head of IBD at Monash Health, who said: “IBD is complex and warrants personalised clinical care from a variety of healthcare professionals whose collective input can improve the quality and speed of decision-making, limit adverse events, improve patient outcomes, and both patient and provider satisfaction.”

Ms Raven said other recommendations from the global report included facilitating speedy diagnosis and specialist referral, improving access to novel treatments, and supporting innovations in treatment and monitoring

She highlighted the efforts of stakeholders in Australia in making the home-based faecal calprotectin test accessible for screening patients with possible IBD. Faecal calprotectin testing was added to the Medicare Benefits Schedule in 2021 as a screening test for selected patients.

GESA has submitted a further application for an MBS item for the faecal calprotectin test in monitoring of IBD patients, which is being considered by the Medicare Services Advisory Committee (MSAC).

According to the GESA application, a faecal calprotectin result in a patient with IBD “offers gastroenterologists important information on disease activity allowing for timely adjustment to therapy (escalation, continuation or de-escalation). In addition, it can provide valuable insights into prognosis.”

The application notes that recent meta-analyses demonstrate a high specificity and sensitivity for faecal calprotectin to detect mucosal healing and disease activity in IBD, and normalisation of faecal calprotectin has also been shown to be associated with reduced risk of disease progression. There is also is a large body of data supporting the utility of faecal calprotectin in predicting relapse, to assist in de-escalation of therapy, and monitoring for post-operative recurrence.

“This application directly supports the findings of the Australian Government’s Inflammatory Bowel Disease National Action Plan 2019 which documented the most important short to medium term actions that will impact the improvement of quality of care for people living with IBD in Australia. Priority area 7 promotes the use of faecal calprotectin which “in the IBD clinical management setting … can assist in monitoring relapse and response of current treatment type and as a surrogate marker of mucosal healing or post-operative recurrence,” the GESA submission states.

The application will be considered by a MSAC subcommittee in December 2023.