IBD-SSHAMP (Supported, Self Help And Management Programme); UK’s First Internet Based Remote

Management System for Managing Stable IBD PatientsM. W. Johnson, K. Lithgo, T. Price

Gastroenterology Department, Luton & Dunstable University Hospital, Luton. LU40DZ. UK.

Introduction

In February 2012 the Luton & Dunstable University Hospital in Bedfordshire, became the first hospital inUK to commence a remote management programme for stable inflammatory bowel disease (IBD) patients via the internet. The project, entitle IBD-SSHAMP (Supported, Self Help And Management Programme), was funded by an Innovation Award presented by the East of England Primary Care Trust Innovation Team.

Aim

The aim was to transfer stableIBD patients from routine hospital based clinic visits, to a safe and efficient remote management system, whilst maintaining a close overview of the patients and their symptoms in the community.

Methods 1

The first stage was to ensure we had a complete and up-to-date database containing all of our IBD patients.After a retrospective 10 year review we identified a total of 2790 IBD patients, from 19 different ethnic backgrounds. Of these, 26 patients lacked mental capacity with learning disability or dementia and 117 did not have internet access. All relevant patient details were uploaded onto the new IBD Database Registry.

Using Patient Knows Best we developed individualise websites to offer a communication portal between patients and the specialist care team, through which we could monitor their symptoms and offer management advice via a traffic light system..

Methods 2

Twice a year the patients are requested to fill out a symptomatic assessment via the internet. Interspersed with this, faecal calprotectin and inflammatory markers will be requested prior to virtual (telephone) clinics held twice a year. If necessary patients can be seen in hospital clinics usually within 24-48hrs. If they score highly on their symptomatic assessments an instant alert is sent out to the IBD team so that directed self management can be provided if neccessary.

Results

Of the available 2,277 IBD patients, we have successfully transferred 100 onto the first wave of IBD-SSHAMP, with a further 300 due to follow shortly in the second wave. We expect confidence in the system to grow amongst clinicians enabling a further 400 to be transferred to IBD-SSHAMP by the end of the year, including those patients stable on immunosuppressants.

With most patients being seen at 6 monthly intervals, and follow up clinic appointments costing our PCT £85, this project could potentially save them £70,000 + per year, whilst still providing a patient friendly and efficient management system.

Conclusion

IBD-SSHAMP is the UK’s first internet based remote management system for managing stable IBDpatients. It aims to reduce cost and free up NHS outpatient time, whilst providing an efficient monitoring and management programme. This is a proof of concept project, from which further data will be collected to prove efficiency and cost benefit.

Cost Savings

IBD - DR = £5,000 PKB = £5,000 ?Calprotectin = £15,000 (2x/y)IBD Nurse = £40,000Virtual OPAs = £27,500

OPAs 800 x 1.5 x £87 = £104,400Saved colonoscopies = £50,000–? Costs saved in reducing– - Hospital admissions– - GP visits– - Surgery– - Opportunistic infections

Total = £92,500 Total = £154,400 +

Table 1; Estimated annual costs and savings involved in the set up and running of IBD-SSHAMP

Data is input into the IBD Database Registry and then shared with patients via their PKB websites

The initial patient log on page for PKB

An example of the iPhone and Android apps designed by PKB

Colour graded chart documenting changes in the severity of different symptoms with time