OC-078 Cost Savings and Outpatient Clinic Appointments Saved: A 2 Year Review of a Nurse Led Telephone Advice Line for Inflammatory Bowel Disease

Abstract

Introduction Due to the different presentations of patients with inflammatory bowel disease, several clinical severity indices were used in the past. Interestingly, most (if not all) of these indices were not properly validated and did not go through a robust methodology. Our aim is to develop a new clinical disease severity index that valid, easy obtainable in the clinic and suitable to all IBD patients. Methods The development of Swansea IBD clinical severity index (SICSI) followed a clinimetric approach. Items were devised using IBD experts opinions and through reviewing 17 clinical severity indices commonly used in studies for UC and CD. To ensure items are applicable, we asked a small focus group of IBD specialists, statisticians and methodologists to review these items and ensure good face and content validity. Psychometric properties were tested on 210 patients to remove redundant items and shorten the index. Construct validity was checked using biochemical markers like CRP, WBC, HB and albumin and clinical indices which are: Harvey Bradshaw index, simple clinical colitis activity index and perianal disease activity index. If patient is having an endoscopy, endoscopic indices will be recorded as well which are mayo clinic score, Rachmilewitz scores and simple endoscopic score. Results We found that 7 items account for 98% of the variance of the total score and they are: Abdominal pain or discomfort, stool consistency compared to the usual, blood in stool, number of stool frequency, general well being, nocturnal symptoms and urgency. Items that had high item total correlation > 0.8 like physician global assessment were removed from the index as they are redundant. Temperature and abdominal mass had a zero variance score and did not add any value to the total score and were removed during factor analysis. Internal consistency (Correlation of items with each other) was acceptable (Cronbach alpha = 0.827). SICSI had good correlation with the clinical, biochemical and endoscopic severity scores (r > 0.5). Conclusion It is clear that the Swansea IBD clinical severity index will perform well in clinical practise. Further studies are going on to implement the index in clincal practise. The index has been incorporated into our local IBD registry to follow up and moniter patients. There are plans to develop an iPhone application.

Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn’s Disease or Ulcerative Colitis

“…Patients describe the IBD nurse as a constant and reliable source of contact providing immediate advice [285,393,395,410]. Prompt access is the most frequently cited benefit of an IBD nursing service from the patient perspective.…”

“…Prompt access is the most frequently cited benefit of an IBD nursing service from the patient perspective. Increased access to the IBD team via telephone AL managed by Advanced IBD Nurses, has also been demonstrated to significantly reduce costs associated with unscheduled primary and secondary healthcare visits [259,285,410]. High levels of patient contact episodes are recorded via helpline services across Europe [285,411].…”

Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004

“…Dies wurde auch von einem Experten-Konsensus im Jahr 2015 von Louis et al zusammengefasst 271 . Auch die verbesserte Akzeptanz von Patient*innen einer solchen zusätzlichen CED-Fachassistenz im Betreuungsnetz konnte in verschiedenen Arbeiten nachgewiesen werden 480 481 , wobei allerdings auch bei allen Untersuchungen zwar zunächst der etwas erhöhte Aufwand für die Fortbildung und Qualifizierung der CED-Fachassistenz betont wurde, aber insgesamt doch kostensparende Effekte im Verlauf nachgewiesen werden konnten 477 482 .…”

“…Zur Effektivität der IBD-Nurse, insbesondere im Hinblick auf die Verbesserung der Kontakte und der Bereitstellung eines schnelleren Arztzugangs, gibt es eine Cochrane-Analyse, die diese positiven Effekte zeigt [475]. Weitere Arbeiten unterstützen diesen schnelleren Zugang zum CED-Zentrum durch die Fachassistenz, insbesondere in Phasen einer erhöhten Krankheitsaktivität mit einer besseren Koordinierung des Terminservice und der ärztlichen Ansprechbarkeit [476,477]. Die fortgebildete CED-Fachassistenz unterstützt zusätzlich die Patient*innen in Belangen der Therapiebegleitung, in der psychosozialen Betreuung und verbessert so deren Befinden [475,478,479].…”

Specialist inflammatory bowel disease nursing in the UK: current situation and future proofing

“…1 While recognised as of great importance and benefit to both individuals living with Crohn's and Colitis, and IBD services, advice lines have been identified by many IBD CNSs as a source of stress and anxiety due to 'unseen workload' and increasing numbers of contact. [12][13][14] Explanations for the increasing stress levels associated with advice line provision include lack of dedicated time within job plans and clarity as to the purpose of the service, resulting in potentially unrealistic expectations about what the advice line can deliver.…”