Biological therapies play an important role in managing complex 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 significant risks to patient safety.

Who’s doing it well?

The gastroenterology team at Lancashire Teaching Hospitals have been actively reviewing and improving the IBD service to meet the growing demands of the local population. The virtual biologic clinic (VBC) has become established to ensure prescribing and monitoring of biological therapies is in line with national and regional guidelines_.

The idea

The Plan-Do-Study-Act (PDSA) cycle was utilised to implement changes as one of the Trust continuous improvement projects. All IBD patients are reviewed and discussed at the weekly VBC prior to their biologic treatment doses. Recommendations are made and the patient management plan is updated upon each review. 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, funding application status is recorded and analysed on weekly interval. Monthly reports are presented to the clinical team as part of the continuous improvement project. Pharmacist intervention is logged as a qualitative measure.

Results

From the 1080 patients reviewed during the 34-week period, 97.4% of patients now have regular review on their biological therapies compared to 60% prior to introduction of VBC. Disease reassessment and monitoring of treatment outcome (as per national standard) is streamlined where blood tests and faecal calprotectin tests are arranged for all new patients at the start of the treatment.

• Compliance with national and regional pathways improved from 58% to 90%.
• The high-cost drug funding completion rate has also risen from 46% to 96%.
• A 20% increase in homecare referrals have been observed since the introduction of VBC as the team actively transfer all eligible patients onto the homecare pathway.
• Patient treatment has been 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 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 pharmacist in VBC.

It shows that the presence of pharmacist in the VBC 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 template, clinician follow-up and relevant monitoring are standardised and streamlined to maintain high level of care. Clinicians feel more confident in managing patients with complicated IBD and appreciate the additional clinical support from the VBC.

Obstacles encountered

One of the obstacles we encountered was lack of admin support for preparation and follow-up post VBC. Therefore, 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 plans for the introduction of a pharmacist led IBD medication helpline to make full use of pharmacist’s expert knowledge. In addition to this, it has been suggested that VBC has shortened the waiting time of biologic therapy initiation.