Introduction Patients with inflammatory bowel disease (IBD) require long-term secondary care with periodic specialist follow-up. This can be especially challenging for patients living in remote areas. One possible solution is the implementation of videoconference (VC) clinics as a distance-management tool. Here we assessed the use of VC clinics for IBD in terms of patient safety and economic benefit for patients with IBD living in rural areas in the Scottish Highlands and Islands. Methods Eighty-eight patients participating in the IBD specialist nurses VC clinic administered via Raigmore Hospital, Inverness, Scotland, UK, between January 2016 and June 2017 were included in this study. A total of 229 appointments were assessed. Results We found the use of a VC clinic to be safe and effective as only 0.9% of appointments required urgent medical assessment and 92% of the VC clinic appointments resulted in further VC clinic follow-up. A total travelling distance of 72,245.3 km and a total travelling time of 71,688 minutes were saved in this patient cohort. It was shown that an average of US$36.61 of potential travelling cost could be saved per appointment. Discussion VC clinics represent a patient-centred participatory model of care for IBD patients living in remote areas with enormous time- and cost-saving potential while being safe and effective. Further investigations into patient satisfaction and the combination with other telemedicine tools such as telephone conferencing and mobile phone applications are needed to evaluate the full potential of the concept.

This study was designed to compare the costs of a pharmacy-based Central Intravenous Additive Service (CIVAS) with those of traditional ward-based preparation of intravenous doses for a paediatric population. Labour costs were derived from timings of preparation of individual doses in both the pharmacy and ward by an independent observer. The use of disposables and diluents was recorded and their acquisition costs apportioned to the cost of each dose prepared. Data were collected from 20 CIVAS sessions (501 doses) and 26 ward-based sessions (30 doses). In addition, the costs avoided by the use of part vials in CIVAS was calculated. This was derived from a total of 50 CIVAS sessions. Labour, disposable and diluent costs were significantly lower for CIVAS compared with ward-based preparation (p < 0.001). The ratio of costs per dose [in 1994 pounds sterling] between ward and pharmacy was 2.35:1 (2.51 pounds:1.07 pounds). Sensitivity analysis of the best and worst staff mixes in both locations ranged from 2.3:1 to 4.0:1, always in favour of CIVAS. There were considerable costs avoided in CIVAS from the multiple use of vials; the estimated annual sum derived from the study was 44,000 pounds. In addition, CIVAS was less vulnerable to unanticipated interruptions in work flow than ward-based preparation. CIVAS for children was more economical than traditional ward-based preparation, because of a cost-minimisation effect. Sensitivity analysis showed that these advantages were maintained over a full range of skill mixes. Additionally, significant savings accrued from the multiple use of vials in CIVAS.

IntroductionMaintenance infliximab (IFX) is established as treatment for Crohn’s Disease (CD) and ulcerative colitis (UC). Efficacy is improved with regular dosing to reduce antibody (Ab) development, though antibodies may anyway develop. The optimal time to stop IFX in remission is unknown: there is no reliable guidance to indicate who will relapse. Patients may be reluctant to stop treatment which has served them well despite significant risks and costs in continuing ineffective treatment. The measurement of IFX drug and Ab levels may help decision-making. Undetectable trough drug levels and high antibody levels (IFX-Ab) may suggest ineffective treatment and support stopping IFX in those in remission. Our centre has measured IFX drug and Ab since Sept 2015. We present how this has influenced patient management.MethodsWe studied 80 IBD patients (55 CD/25 UC) receiving regular IFX to maintain remission. IFX trough drug levels and IFX-Ab levels were measured in all patients between Sept and Dec 2015. Samples were analysed at Exeter Clinical Laboratory International. Disease activity was assessed by the Harvey-Bradshaw Index (HBI) at time of last infusion and the most recent faecal calprotectin was recorded for each patientResultsIFX was given at a median interval of 2 months (range 1–3 months) for a median of 29 months (range 5–130). 39 out of 80 had immunosuppression with azathioprine/6 MP or methotrexate when levels were measured. Eighteen (13 Crohn’s/5 UC) of 80 patients had no detectable IFX in the presence of IFX-Ab (median 328 AU/ml range 12 to >500). This group had a similar duration of treatment (median 25 months range 8–89 months) but were less likely to be on immunosuppressant medication (4/18). Of these 18, 2 were clinically relapsing. The remaining 16 appeared in remission or minimally active (HBI median 1.5, range 0–6 a patient with bile-salt diarrhoea excluded), the median faecal calprotectin levels was 72 µg/g (range <30 to 249) a median of 4 months from measured IFX levels. Results were discussed with patients and the decision made to stop IFX treatment. Immunosuppressant medication was started as appropriate. A further 18 patients had IFX-Ab in the presence of a measurable trough drug levelConclusionIn 80 IBD patients on maintenance IFX, 16 (20%) had no detectable IFX trough levels but significant levels of IFX-Ab whilst in remission. Routine measurement of IFX levels and Ab as part of routine clinical practice may identify patients receiving no benefit from maintenance therapy, reducing costs, risks and treatment burden. Ongoing study is necessary to determine outcomes of patients stopping biologics and of patients in whom infliximab levels and infliximab antibodies co-existDisclosure of InterestNone Declared