P0318 Rapid access clinics for Inflammatory Bowel Disease improve access and outcomes but additional service support is required: Experience from the AWARE-IBD Quality Improvement Programme in the United Kingdom
Authors: Mccormick S , Robinson K , Ezaydi N , Ainley R , Lobo A J ,   Sheffield AWARE-IBD (R. Ainley, J. Armitage, A.J. Brooks, R. Campbell, T.S. Chew, N. Ezaydi, M. Hale, D. Hind, A.J. Lobo, S.J. McCormick, L. Marshall, M. Nalishuwa, A.M. Phillips, A. Rej, K. Robinson, E. Sheldon, G.Z. Tun, L. Thompson, J. Turner, A. Wright)
Published: January 2025

Abstract

Background
There is increasing attention to quality of Inflammatory Bowel Disease (IBD) services, which are under pressure from rising disease prevalence, increasing disease complexity and a wide range of treatment options – all within constrained resource and capacity. There is limited information on the impact of patient-led service changes in a ‘real-life’ clinic setting.

Methods
The Sheffield IBD service (UK) implemented the AWARE-IBD patient-led quality improvement (QI) programme of co-designed service change in a microsystem. Designated clinics were allocated for patients prioritised by the microsystem: 1) those with a suspected flare contacting a telephone advice line; 2) starting or changing advanced treatment; and 3) new IBD diagnosis at endoscopy. Appointments were allocated for each of these groups in 3 clinics per week during 2 tests of change (ToC) (ToC 1: 14/11/22 - 25/11/22; ToC 2: 17/04/23 - 26/05/23) and outcomes compared to a prior baseline interval (01/06/22 - 30/06/22). Qualitative feedback was obtained in semi-structured interviews.

Results
Group 1. Suspected flare (Figure 1): more patients were seen in defined clinics (baseline 8/202 (4.0%); ToC 62/285 (17.9%; p&lt;0.0001) with reduced admissions (baseline 26/202 (12.9%), during ToC 21/347 (6.1%); p=0.006) and investigation (baseline 57/202 (28.2%), ToC 61/347 (17.6%); p=0.003).
Group 2. Advanced therapy: more patients were seen within 14 days of the multi-disciplinary team meeting (MDT) to discuss initiation or change (baseline 7/31 (22.6%); ToC 20/32 (62.5%; p=0.001), but with no difference in numbers starting treatment within 28 days.
Group 3. New diagnosis: more patients were seen within 30 days of endoscopic diagnosis (baseline 6/27 (22.2%); ToC 14/20 (70%); p=0.001), but not within 14 days. Time to start treatment was not impacted.
Interviews indicated reassurance from rapid help and benefits of in-person consultation, improved trust in the healthcare team, and greater confidence for self-management alongside the clinics.

Conclusion
Rapid access clinics improve access for defined groups, reducing admission and investigation in those with a suspected flare but a minority were accommodated in clinic. Robust arrangements to train and support staff giving complex advice on an advice line are therefore needed. Additional factors such as patient availability, infusion capacity and screening influence time to start advanced treatments. Rapid review after endoscopic diagnosis supports detailed information provision. Services can use QI programmes and iterative tests of change to inform resource allocation and identify key parts of a pathway to affect outcomes.