Taylor Nicola S, Bettey Marion, Wright Julia, Underhill Caron, Kerr Sarah, Perry Kim, Cummings Jr Fraser
Department of Gastroenterology, Southampton General Hospital, Southampton, UK.
Pharmaceutical Commissioning, Eastleigh, UK.
Frontline Gastroenterol. 2016 Oct;7(4):283-288. doi: 10.1136/flgastro-2016-100696. Epub 2016 Jul 7.
Southampton General Hospital provides inflammatory bowel disease (IBD) services for a population of 650 000. Biological agents have impacted hugely on IBD but are costly drugs requiring careful supervision. These challenges led us to develop a specialist nurse-led biologics service to improve patient care.
A 2010 case note audit highlighted areas for improvement in monitoring biologics and follow-up. A business case was developed to establish an IBD nurse to ensure identification and appropriate screening, education and review of biologics patients. A gain share was agreed with the local Care Commissioning Group (CCG) and £60 000 invested. Outcomes were reaudited in 2014.
Biologic use has grown rapidly from 90 patients in 2011 to 330 in 2014. All records are now kept in a centralised database. Infection screening improved from 79% to 100%. In 2014, 96% of patients had follow-up ≤4 months post-induction to assess response, but two patients were seen at 7 months. 80% were followed up again at 9-12 months (100% at 9-14 months), all with treatment decisions. The initial investment was recouped via commissioners funding 368 additional outpatient appointments and 35 colonoscopies. Savings represented 15% total yearly biologic costs.
The introduction of the IBD biologics nurse-led service resulted in significant gains in care quality and costs. The need for improved follow-up of patients on biologics reflects increased pressures on clinic resources across the country. With continued biologics expansion, the introduction of a biologics nurse has provided invaluable support to patients and the IBD team at Southampton General Hospital.
南安普敦综合医院为65万人口提供炎症性肠病（IBD）服务。生物制剂对IBD产生了巨大影响，但这些药物成本高昂，需要仔细监管。这些挑战促使我们开发了一项由专科护士主导的生物制剂服务，以改善患者护理。
2010年的病例记录审核突出了生物制剂监测和随访方面需要改进的领域。制定了一份商业计划，以设立一名IBD护士，确保对使用生物制剂的患者进行识别、适当筛查、教育和复查。与当地医疗委托小组（CCG）达成了收益分成协议，并投入了6万英镑。2014年对结果进行了重新审核。
生物制剂的使用量从2011年的90名患者迅速增加到2014年的330名。现在所有记录都保存在一个集中的数据库中。感染筛查率从79%提高到了100%。2014年，96%的患者在诱导治疗后≤4个月接受了随访以评估反应，但有两名患者在7个月时才接受随访。80%的患者在9 - 12个月时再次接受了随访（9 - 14个月时为100%），所有患者都做出了治疗决定。最初的投资通过委托方资助的368次额外门诊预约和35次结肠镜检查得以收回。节省的费用占生物制剂年度总成本的15%。
由IBD生物制剂护士主导的服务的引入在护理质量和成本方面取得了显著成效。对使用生物制剂的患者加强随访的需求反映了全国诊所资源面临的压力不断增加。随着生物制剂的持续推广，生物制剂护士的引入为南安普敦综合医院的患者和IBD团队提供了宝贵的支持。
