The impact of nurse-led annual telephone follow-up of patients with inflammatory bowel disease

Inflammatory bowel diseases (IBD) are characterised by periods of disease activity and period with disease in remission. In Denmark all patients are seen in hospital settings. The aim of this study was to introduce a nurse-led phone service for stable patients replacing annual visits. The study originated from an outpatient cohort of 1,600 patients with IBD. A research protocol was determined before the intervention was launched, which included surveys among the patients before the intervention, after the intervention, collection of longitudinal data in a three year period, and a clinical audit. Budget impact analysis (BIA) and cost-effectiveness analysis (CEA) were done. Furthermore, the staff evaluated the process. Almost 30% (n = 474) of the total cohort was enrolled in the service. Eighty-seven per cent of the patients welcomed the phone service beforehand. After implementation, 94% of the patients included were pleased with the service. The programme has shortened the waiting time for most other services, but no improvement in the workload was observed. The BIA showed limited savings. The CEA showed an annual saving of 100€ per patient when using the annual phone service over routine visits. In conclusion, changing the method of contact from routine annual visits to annual phone calls from a nurse was feasible and well accepted for stable patients with IBD. The benefits of the service were most marked for the patients. Problem Patients with inflammatory bowel diseases (IBD) are often seen by a doctor on a regular basis in the hospitals outpatient clinics regardless of disease activity or not. The follow-up and treatment of patients with IBD is continuous to postpone relapse and prolong the period of disease remission. The majority of IBD patients are diagnosed while in their twenties. Therefore, many patients are quite young and are studying or are in the labour market. Appointments in the outpatient clinic can therefore become costly for the patients and might as well be replaced by telephone calls if the disease is in-remission.