IBD helpine cuts outpatient clinic load

Wednesday, 14 Aug 2019

A nurse practitioner helpline for IBD clinic patients is playing a valuable role in drug safety monitoring as well as reducing unplanned admissions and outpatient clinic load, Victorian gastroenterologists say.

The IBD telephone support service offered to patients of the IBD clinics at Eastern Health, Melbourne, is fielding 100 calls a month, according to a report by Dr Steven Nicolaides and colleagues at Box Hill Hospital

Their review of helpline data from three months found that the main reason for 30% of the 300 calls was for follow-up of test results for immunomodulator and/or thiopurine metabolite monitoring and toxicity.

About 13% of calls related to patient concerns regarding symptoms, with 11% having a suspected disease flare.

For patients with a suspected flare, 59% had a management strategy mostly comprised of escalation of 5-ASA dose/administration (31%) and/or commencing corticosteroids (28%).

Active disease was confirmed in those where disease flare was suspected, in whom median faecal calprotectin levels were 540mg/kg and serum CRP was 26.9mg/L.

Almost 50% of the callers to the Helpline were female and 61% had Crohns Disease.

In their report published in Journal of Crohns and Colitis, Dr Nicolaides note that 22% of calls resulted in an emergency department presentation. Unplanned inpatient hospitalisation occurred in 15.6% of cases, which compared well to the benchmark of 68% unexpected admission rate for IBD patients seen in the same centre prior to setting up the IBD Helpline.

“The implementation of an IBD helpline efficiently manages ad hoc patient queries and coordinates drug safety monitoring, reducing workload on busy outpatient clinics,” concluded Dr Nicolaides and colleagues.

Moreover, a helpline appears to triage and reduce unplanned inpatient healthcare utilisation which has significant cost impact for health payers, and should improve patient quality of life.

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