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P574 IBD patients should be stratified to guide out-of-hospital monitoring: ICHOM-derived outcomes from a dedicated IBD telephone clinic

R. K. Fofaria*1, S. Azana1, G. Grande1, P. Naeck-Boolauky1, T. Tyrrell1, N. Arebi1

1St Mark's Hospital, IBD Department, London, UK

Background

The prevalence of IBD in western countries is high. Once diagnosed most patients are monitored in hospitals. Out-of-hospital (OOH) monitoring through various electronic portals offers patient-centred care. Some IBD patients are at risk of complications from disease progression or drug therapy, but many have a low risk of adverse outcomes and may be safely monitored OOH. Several tools to deliver OOH care are described. In contrast, guidance to select low-risk patients for OOH and their outcomes using validated patient-reported outcomes such as International Consortium for Health Outcomes Measurement (ICHOM) are lacking. We selected low-risk patients for telephone OOH and describe their outcomes.

Methods

Over 18 months, 1083 IBD patients from 3 non-complex IBD clinics were stratified according to pre-specified criteria formulated with patient input and offered OOH care. Inclusion criteria were (a) age ≥ 18 years, (b) confirmed diagnosis of IBD ≥ 1 year, (c) low risk of developing IBD-related complications, (d) clinical remission (see Figure 1). Exclusion criteria were i) learning/language difficulties ii) pregnancy, iii) awaiting IBD MDT discussion. Patient-reported outcomes, quality of life and healthcare utilisation as defined from the ICHOM standard set were prospectively collected at the index telephone consultation.

Figure 1. Remission and risk stratification definitions.

Results

362/1083 patients were eligible for telephone clinics; 115 (32%) patients were transferred. Patient demographics, IBD subtype, current medication (nil, 5-ASA or immunomodulator therapy), outcome data and follow-up interval are shown for the 115 patients presented below (see Table 1):

Table 1. Results.

Conclusion

IBD patients with a low risk of complications and durable clinical remission, showed good outcomes with OOH telephone monitoring. Healthcare utilisation and recent steroid use as defined by ICHOM outcomes were low. Selecting the right patients for OOH monitoring may be the preferred strategy to show beneficial patient-reported and clinical outcomes and maintain adherence to telephone monitoring. Our findings should encourage patient stratification based on presumed risk and disease activity.