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N802 Improving care for patients with perianal Crohn's disease; review of a perianal virtual clinic

Yarrow H., Irving P., Williams A., Hibberts F., Koumoutsos I., Darakhshan A., Westcott E., Duncan J.

Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, London, United Kingdom

Background

Effective communication within the inflammatory bowel disease (IBD) team is essential to the management of perianal Crohn's disease (PCD). We identified that medical, nursing and surgical care could be fragmented for patients with complex PCD. To address this we developed the perianal virtual clinic (PVC); a quorum of gastroenterologists, surgeons, and clinical nurse specialists who meet once weekly for 2 hours. Virtual review of patients with complex PCD is combined with up to 2 patients face to face.

Methods

PVC review includes evaluation of clinical symptoms, radiological investigations and biochemical markers. Medical management is optimised using drug levels and anti-drug antibodies and further radiological assessment or clinic review is arranged as appropriate. Patients reporting acute PCD activity are invited to attend the clinic where we offer a seamless one-stop service from assessment to surgery. This includes examination, discussion of treatment options, relevant screening, consent and surgical pre-assessment. PVC activity and outcomes have been reviewed between January and June 2016.

Results

During this period we reviewed 69 virtual patients and 31 acute cases face to face.

Virtual: 31/69 were booked for a EUA directly from PVC; 45% of these were approved to commence a biologic following this. 14 were booked a routine outpatient appointment. 5 had their MRI reviewed without need for treatment alteration and 7 booked face to face for assessment and optimisation of medical treatment. 5 patients had an MRI prior to commencing biologics and approved to start without further surgical drainage. 7 had their future MRI scans planned for on-going monitoring.

Face to face: 16/31 were scheduled straight to EUA following surgical assessment and biologics were optimised soon after. Medical therapies were optimised in a further 5 patients utilising antibiotics and biologics. 3 were booked for perianal MRI with subsequent EUA. 1 had their luminal reassessment with colonoscopy and small bowel MRI. 2 were booked for luminal surgery.

A further 4 were assessed following EUA to review response and plan future care.

Conclusion

PVC is an effective way of managing PCD ensuring an efficient interface between surgical, medical and nursing teams. This has led to more timely surgical interventions and early appropriate initiation of biological therapies. Those patients who attend the urgent face to face clinic have a one-stop service from assessment to consent and surgical pre-assessment.