IBD SSHAMP Dr. Matt W. Johnson Inflammatory Bowel Disease Supported, Self Help And Management Programme

Backgound The L&D Hospital catchment = 330,000 No. of IBD = 2842 Each are seen approx 1-2 x / year Since on PSMPs

New Challenges 2008 National IBD Audit –Major regional differences in IBD service provision 2009 IBD National Standards (BSG) –Minimum standards of care ECCO (European Crohn’s and Colitis Organisation) + BSG guidelines –New immunity assessment and management protocol Patient Satisfaction Surveys QUIPP - major drive to provide community based self management care

IBD-SSHAMP a) Functional Database - IBD-DR b) Communication - PKB Patient Portal c) Distance Monitoring - Virtual OPA+Calprotectin

a) National IBD - DR Data is uploaded locally Every patient is listed Aspects are pooled Nationally Benefits Instant patient letters Generates worklists Generates reminders Enables analysis of any data-subsets

b) Patient Knows Best Communication portal between patient and specialists (+/- GPs) Health passport Personalised management plans Library of advice sheets Disease activity assessment Targeted management advice Specialist overview from a distance

c) Virtual Clinics + Calprotectin Telephone clinic 1-2x / year Automated testing + Reminders on IBD-DR –Disease activity 1-2 x / year –Blood tests 1-2 x / year –Bone density 1 x / 2-3 years –Colonoscopy surveillance 1,3 or 5 years –Faecal calprotectin 1-2 x / year –Immunity assessments 1 x / year Vaccinations NB - Faecal Calprotectin 93% sensitive and 96% specific at differentiating between Functional and Organic bowel disease (MBJ Meta-anaysis. 2010;341:c3369) Calprotectin can be used to predict a flare as the levels rise 2-3m before the symptomatic flare occurs (Tibble J. Gastro. 2000; 119:15-22).

Clinical Benefits ReduceImprove Flare ups Hospital attendance and admission Negative impact on daily activities eg. work Opportunistic infection rate Surgical complications rate Morbidity and mortality Patient satisfaction Disease monitoring Access to specialist advice Empower patients Confidence and knowledge to self manage Overview of community management

Financial Benefits ReduceImprove GP clinic visits Hospital clinic visits Unnecessary radiological procedures Unnecessary colonoscopies performed Hospital admissions Surgical interventions. Vaccination rates

Cost, Sustainability and Dissemination CostSavings IBD - DR = £5,000 ? PKB = £5,000 ? Calprotectin = £15,000 IBD Nurse = £40,000 OPAs 800 x1.5 x £87 = £104,400 Saved colonoscopies = £50,000 –? Preventing hospital admissions, GP visits, surgery, opportunistic infections etc. Total = 65,000Total = £154,400 +

Graham Holland’s ‘the optimism and the frustration of living in a metropolis’