P0624 Adherence to a Care Pathway for Inflammatory Bowel Disease in the Southwest region of the Netherlands

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Abstract Background In the southwest of the Netherlands, there is a close collaboration between hospitals to improve care for inflammatory bowel disease (IBD). This collaboration aims to deliver high quality and uniform care across the region. To achieve this, a care pathway (CP) was developed and implemented for treating IBD with biologics and small new molecules. The CP consists of subsets that address initiation and switching of therapy, frequency and type of follow-up. This study aims to assess adherence to the CP and determine barriers and facilitators of the development and implementation. Methods A mixed-methods study was conducted using quantitative data to evaluate the adherence to the CP per subset. Quantitative data was retrospectively collected from electronic medical records (EMR) from December 2020 until March 2023. Surveys and semi-structured interviews were used to identify barriers and facilitators, using the Extended Normalization Theory. Surveys were sent to all healthcare providers (HCPs) and interviews were conducted with gastroenterologists, IBD-nurses, healthcare assistants and IT-personnel. Results Adherence to the CP regarding the registration of discussed treatment options was 50%. Weight measurements ranged from 12% to 25% across different CP subsets. Smoking status and medication side effects were documented in respectively 30% and 33% of patients. Validated questionnaires were rarely used to record disease activity, with adherence rates between 6% and 20%. Only 25% of patients who started or switched biologics were screened for HIV, tuberculosis and hepatitis B and C. Outpatient visits were scheduled according to the CP in 67% to 75% across CP subsets. Blood tests were ordered as per CP, or an exemption was registered in 25% to 42%. Microbiology tests were ordered according to the CP in 52% of patients experiencing a flare. Of the 85 surveys distributed to HCPs 42 were completed and 11 interviews were conducted. Facilitators of the CP were improving collaboration between HCPs, the potential to standardise IBD care, and that the CP is user-friendly for HCPs. Barriers included the complexity of the implementation of the CP in EMR, the difficulty for HCPs to change their current routine, and the heterogeneity of IBD. Conclusion A CP for the treatment of IBD with biologics and small new molecules has been implemented to improve patient care, however, adherence appears to be challenging. Despite the barriers, the CP is well designed and offers sufficient flexibility to personalise care where necessary. A possible reason for the adherence results may be the limited registration in EMR by HCPs. This could be improved by audit and feedback sessions, to communicate current adherence and improve implementation in daily practice.

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