The work described here was presented at the UKCPA Virtual Conference Poster Day 2021
Biological therapies play an important role in managing complex Inflammatory Bowel Disease (IBD) patients, but they also pose significant risk to patients if not managed or monitored appropriately.
The lack of consistency in clinician follow ups and reviewing treatment outcomes pose risks to patient safety. The gastroenterology team at Lancashire Teaching Hospitals NHS Foundation Trust (LTHTR) have been actively reviewing and improving the IBD service to meet the growing demands of the local population.
The virtual biologic clinic was established to ensure that prescribing and monitoring of biological therapies is in line with national and regional guidelines. The Plan-Do-Study-Act cycle was used to implement changes as one of the Trust’s continuous improvement projects. All IBD patients are reviewed and discussed at the weekly virtual biologic clinic prior to their biologic treatment doses. Recommendations are made and the patient management plan is updated upon each review.
To evaluate the virtual biologic clinic, data was collected over a 34 week period.
The database for each biologic therapy is updated on regular basis. Data, including standard blood and disease monitoring, dosing interval and funding application status, is recorded and analysed weekly. Monthly reports are presented to the clinical team as part of the continuous improvement project. Pharmacist intervention is logged as a qualitative measure.
Of the 1080 patients reviewed during the 34 week period, 97 percent had a regular review on their biological therapies, compared to 60 percent prior to the introduction of the virtual clinic.
Clinicians feel more confident in managing patients with complicated IBD and appreciate the additional clinical support from the virtual biologic clinic
Disease reassessment and monitoring of treatment outcome (as per the national standard) is streamlined where blood tests and faecal calprotectin tests are arranged for all new patients at the start of their treatment. Compliance with national and regional pathways improved from 58 percent to 90 percent. The high cost drug funding completion rate also increased from 46 percent to 96 percent. A 20 percent increase in homecare referrals were observed since the introduction of the clinic as the team actively transfer all eligible patients onto the homecare pathway. In addition, patient treatment was optimised in a safe and timely manner that could result in an estimated £100k annual saving to the Trust.
Pharmacist involvement is vital to ensure that biological therapy is prescribed, ordered and supplied in a safe and timely manner. Any potential drug-drug interactions and non-compliance with medications are highlighted by the pharmacist in the virtual biologic clinic.
This study demonstrates that the presence of a pharmacist in the virtual biologic clinic can minimise prescription duplication and reduce medicine wastage. It also enhances communication between the IBD team and pharmacy homecare team, resulting in efficient homecare referral.
Clinic letter templates, clinician follow-up and relevant monitoring are standardised and streamlined to maintain a high level of care. Furthermore, clinicians feel more confident in managing patients with complicated IBD and appreciate the additional clinical support from the virtual biologic clinic.
It has been suggested that extra clerical and pharmacy technician support may provide a better skill mix and more time efficient clinic time. There are also plans for the introduction of a pharmacist-led IBD medication helpline to make full use of pharmacists’ expert knowledge.
The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.
Competing interest statement:
The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.