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N002 Healthcare professional advice to patients regarding topical therapies in Inflammatory Bowel Disease

T. Tyrrell1, K. Greveson*2, J. Duncan3, N. Christine4

1St. Mark's Hospital , IBD Unit, Harrow, United Kingdom, 2Royal Free Hospital, Department of Gastroenterology, London, United Kingdom, 3Guy's & St Thomas' NHS Foundation Trust, Gastroenterology, London, United Kingdom, 4Kings College, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom

Background

A combination of both topical (suppositories or enemas) with oral mesalazines are first line treatments for mild to moderately active left sided colitis1,2 . There is evidence that topical therapy achieves higher rectal mucosal mesalazine concentrations than oral therapy3, Members of the UK Royal College of Nursing4 (RCN) IBD Nurse network in London and southeast region perceived there was variability in the advice given to patients prescribed topical treatments and aimed to investigate this.

Methods

An online audit was conducted between April-October 2014. A 20-item questionnaire was developed using Survey Monkey®. The questionnaire link was distributed by email to nurse members of the UK RCN IBD Network with a request to additionally forward it to non-IBD nurse colleagues.

Results

Healthcare professionals (HCPs) (86) who completed the questionnaire included nurses n=70, Gastroenterologist n=8, Specialist medical Registrar n=7, ward nurse n=1. Thirty eight responders were independent prescribers. The majority reported that patients generally accept topical treatments (69/86, 80%). The main barrier for using topical treatments was perceived as the patient's unwillingness to use (65/86,( 76%), inconvenience to patients (50/86, 58%), inability to retain the treatment (51/86, 59%) and poor patient education on its use (42/86, 49%). Site of disease (81/86, 94%) and previous clinic efficacy (72/86, 84%) were the top influences to choose topical therapy. During patient education some professionals used examples of products to show the patient (25/86, 29%), used booklets (23/86, 27%) or visual aids (38/86, 44%). Patients were advised to lie down (44/86, 51%) or to use however they find comfortable (33/86, 38%) to administer topical preparations. Night time was the most usual time to advise patients to use the preparation (67/86, 78%). Lubricant use was advised by 34 (40%) professionals. Patients were advised to use topical treatment until symptoms improve (46/86, 53%). Only 46/86 (53%) of healthcare professionals felt that they had adequate information to give to patients.

Conclusion

HCPs perceive that patients accept topical treatment. However there are significant variations in advice and education provided. There appears to be a paucity of supporting educational aids. A further questionnaire study is planned exploring the patient's experience of using topical treatment.

References:

[1] Dignass A, Lindsay JO, Sturm A, Windsor A, Colomble, JF, Allez M. etal. , (2012), Second European evidence-based consensus on the diagnosis and management of Ulcerative Colitis Part 2: Current management. , Journal of Crohn's and Colitis -JCC, 6: 991-1030

[2] National Institute for Health and Care Excellence. , (2013), Ulcerative Colitis. Management in adults, children and young people., NICE, p1-37

[3] Pimpo MT, Galletti B, Palumbo G, Viscido A, Gentile P, Caprilli R etal, (2010), Mesalazine vanishing time from rectal mucosa following its topical administration., JCC , Journal of Crohn's and Colitis -JCC, 102-5

[4] Royal College of Nursing, (2014), RCN Inflammatory Bowel Disease (IBD) Network, http://www.rcn.org.uk/development/nursing_communities/rcnfourms/gastrointestinalnursingfourm/inflammotoryboweldisease