Changing face of care for patients with moderate to severe inflammatory bowel disease: the role of specialist nurses in the governance of anti- TNF prescribing.

Connell, W. R.; Samyue, T.; Gibson, P. R.; Lachal, S.; Moore, G. T.; Macrae, F. A.; Van Langenberg, D. R.

Background Anti-tumour necrosis factor ( TNF) therapy is highly effective for inflammatory bowel disease ( IBD), but expensive and potentially toxic. Meticulous supervision prior to and during anti- TNF treatment is required to screen and monitor patients for adverse clinical events. In addition, a systematic administrative process is necessary to comply with Australian Medicare requirements and ensure ongoing therapy is uninterrupted. IBD nurses are essential components of multidisciplinary IBD services, but their role in facilitating the safe and timely delivery of anti- TNF drugs is unacknowledged. Aim The aim of the study was to calculate time spent by IBD nurses on anti- TNF drug governance and its indirect cost. Methods Time spent on activities related to anti- TNF governance was retrospectively assessed by questionnaire among IBD nurses employed at Melbourne hospitals. The capacity of IBD clinics at these hospitals was separately evaluated by surveying medical heads of clinics. Results On average, each Melbourne IBD service handled 150 existing and 40 new anti- TNF referrals in 2013. The average annual time spent by nurses supervising an existing and newly referred anti- TNF patient was 3.5 and 5.25 h respectively, or a minimum of two full working days per week. If clinicians undertook this activity during normal clinic time, the organisational opportunity cost was at least 58%. Conclusions Anti- TNF therapy governance is an essential quality component of IBD care that is associated with a definite, indirect cost for every patient treated. IBD nurses are best positioned to undertake this role, but an activity-based funding model is urgently required to resource this element of their work.

VICTORIA; TUMOR necrosis factors; INFLAMMATORY bowel diseases; MEDICAL care; MEDICAL cooperation; MEDICAL specialties & specialists; NURSES; PATIENTS; QUESTIONNAIRES; RESEARCH; OCCUPATIONAL roles; RETROSPECTIVE studies; DESCRIPTIVE statistics; THERAPEUTICS

Internal Medicine Journal, 2015, Vol 45, Issue 11, p1161

1444-0903

Academic Journal

10.1111/imj.12861