Gastroenterologists will begin receiving education visits later in June under the government’s Value in Prescribing program to encourage best practice in treating IBD with bDMARDs.

The Targeted Therapies Alliance, which includes GESA among its stakeholders, does not plan at this point to delve into the prescribing patterns of individual practitioners as it did with rheumatologists in the first round of the $8.2m VIP initiative.

“The overall goal to have best practice prescribing of biologic DMARDs,” Associate Professor Jake Begun, chair of the IBD faculty of GESA,  told the limbic.

“We recognise that they are of significant cost to the health system in Australia and so we want to be using the medicines in the best way possible while recognising they have incredibly good outcomes for our patients who are on them appropriately.”

In the round focusing on gastroenterology, the program will be aimed at GPs, general gastroenterologists and gastroenterologists with a special interest in inflammatory bowel disease, Associate Professor Begun said.

“The idea is to make sure you are using conventional medications optimally for ulcerative colitis and Crohn’ disease, including methotrexate.  And when looking at biologics, it is also a matter of appropriate doses – recognising when patients need to be escalated on biologics and when some patients can be safely de-escalated.”

Evidence from PBS prescribing data indicated some patients who qualified for biologics had not been prescribed immunomodulating therapies, he said.

Dr Jonathon Dartnell, programs and clinical services manager of strategy, programs and delivery at NPS MedicineWise, said about 200 gastroenterologists who specialised in treating IBD would receive approaches for the education visits.

“Hopefully, we will be able to do more,” he said. Putting the scale of the outreach in perspective, NPS conducts education visits to some 20,000 GPs per year, he added.

The discussions with gastroenterologists would be more tailored, he added.

“It will be a conversation about the evidence we’ve been able to summarise and reflecting on how that evidence might be used.

“We will be trying to identify gastroenterologists who are prescribing bDMARDS or biologicals for inflammatory bowel disease because they will have the greatest interest in what we have to offer.

“We will be distilling the evidence as best we can based around important questions that the gastroenterologists face in day-to-day practice. Through the feedback we gain from that, we can work out what they value and how we can do it better next time.”

Along with an ongoing webinar series, new resources in the pipeline include a tool to support the use of biosimilars and help practitioners be aware of the possibility of a nocebo effect from the way they might communicate about biosimilars, Dr Dartnell said.

“There’s also a decision aid to be used with aminosalicyates in ulcerative colitis, and action plans for use of thiopurines in Crohn’s disease and low-dose methotrexate in Crohn’s disease.”

He said the three-year ‘Value in Prescribing’ program is putting emphasis on outcomes and efficiency rather than cost savings.

“In formative research, we found that gastroenterologists have good understanding of biologics and biosimilars, but were not quite familiar with the processes behind their funding and availability through PBAC decision making,” he said.

It could be helpful for specialists “to understand how the use of biosimilars contributes very significantly to creating a more competitive market and reducing prices overall”, he added.

He said there was no plan for PBS practice reviews comparing individual clinicians’ prescribing with that of their peers.

“With the rheumatologists, we could focus in on, for example, subcutaneous methotrexate which is not used so much in Australia and could be used more.  There was not the equivalent opportunity to do that with gastroenterology.”

More broadly, Dr Dartnell said input from GESA had highlighted the opportunity for better knowledge about the use of fecal calprotectin, and rapid referral and better first-line management, which could lead to better outcomes and may offset the need for biologics.

“If first line management is optimised, perhaps there’s not a need to go on to a biologic.  Whereas if referral comes too late, then maybe the opportunity has been a bit lost.”