Download IBD-SSHAMP

IBD SSHAMP
Inflammatory Bowel Disease Supported,
Self Help And Management Programme
Dr. Matt W. Johnson
Backgound
• The L&D Hospital catchment = 330,000
• No. of IBD = 2842
• Each are seen approx 1-2 x / year
• Since 2006 - 440 on PSMPs
New Challenges
• 2008 National IBD Audit
– Major regional differences in IBD service provision
• 2009 IBD National Standards (BSG)
– Minimum standards of care.
• 2010 ECCO (European Crohn’s and Colitis Organisation) + BSG
guidelines
– New immunity assessment and management protocol
• Patient Satisfaction Surveys
• QUIPP - major drive to provide community based self management
care
IBD-SSHAMP
•
a) Functional Database - IBD-DR
•
b) Communication
•
- PKB Patient Portal
c) Distance Monitoring - Virtual
OPA+Calprotectin
a) National IBD - DR
Data is uploaded locally
Every patient is listed
Aspects are pooled
Nationally
Benefits
Instant patient letters
Generates worklists
Generates reminders
Enables analysis of any
data-subsets
b) Patient Knows Best
Communication portal
between patient and
specialists (+/- GPs)
Health passport
Personalised management
plans
Library of advice sheets
Disease activity
assessment Targeted
management advice
Specialist overview from a
distance
c) Virtual Clinics +
Calprotectin
• Telephone clinic 1-2x / year
• Automated testing + Reminders on IBD-DR
–
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–
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Disease activity
Blood tests
Bone density
Colonoscopy surveillance
Faecal calprotectin
Immunity assessments
1-2 x / year
1-2 x / year
1 x / 2-3 years
1,3 or 5 years
1-2 x / year
1 x / year Vaccinations
• NB - Faecal Calprotectin 93% sensitive and 96% specific at differentiating between
Functional and Organic bowel disease (MBJ Meta-anaysis. 2010;341:c3369)
• Calprotectin can be used to predict a flare as the levels rise 2-3m before the
symptomatic flare occurs (Tibble J. Gastro. 2000; 119:15-22).
Clinical Benefits
Reduce
Flare ups
Hospital attendance and admission
Negative impact on daily activities eg.
work
Opportunistic infection rate
Surgical complications rate
Morbidity and mortality
Improve
Patient satisfaction
Disease monitoring
Access to specialist advice
Empower patients
Confidence and knowledge to self
manage
Overview of community management
Financial Benefits
Reduce
GP clinic visits
Hospital clinic visits
Unnecessary radiological
procedures
Unnecessary colonoscopies
performed
Hospital admissions
Surgical interventions.
Improve
Vaccination rates
Cost, Sustainability and
Dissemination
Cost
IBD - DR
PKB
Calprotectin
IBD Nurse
= £5,000 ?
= £5,000 ?
= £15,000
= £40,000
Total
= 65,000
Savings
OPAs 800 x1.5 x £87 =
£104,400
Saved colonoscopies =
£50,000
– ? Preventing hospital admissions,
GP visits, surgery, opportunistic
infections etc.
Total
= £154,400 +
Graham Holland’s
‘the optimism and the frustration of living in a metropolis’