title: A nurse-driven outpatient clinic for thiopurine-treated inflammatory bowel disease patients reduces physician visits and increases follow-up efficiency.
abstract: Patients on thiopurine therapy need frequent monitoring to prevent drug adverse events. To describe the structure and main results of a nurse-driven outpatient clinic (NDOC) program for the follow-up of patients receiving treatment with thiopurine immunosuppressants, we retrospectively reviewed patients' clinical charts on thiopurine drugs, azathioprine (AZA), and 6-mercaptopurine. We evaluated the efficacy of the NDOC by comparing the number of physician visits and the adequacy of laboratory controls for each patient before and after inclusion in the program. From January 2006 to December 2008, 179 patients were included. Of these, 102 had received thiopurines for at least 1 year before the start of the NDOC. Mean age was 42 ± 15 years; 83 were female. In all, 137 of the 179 patients (76%) had Crohn disease. AZA was the most frequent drug used (97%). Mean time of follow-up was 2.03 ± 0.9 years. Implementation of this program decreased the number of physician visits per year-from 4.6 ± 1.9 to 2.4 ± 1.3 (p < .001)-and the number of periods longer than 4 months without laboratory control (from 68% to 45%; p = .01). Leucopenia episodes and complications did not differ significantly before and after the start of the NDOC. Nurse-driven follow-up of these patients reduces physician visits while improving tightness of the follow-up.
authors.affiliation: María López, MSc, Infermeria, Hospital de Sabadell, Sabadell (Barcelona), Spain. Angelina Dosal, RN, Infermeria, Hospital de Sabadell, Sabadell (Barcelona), Spain. Albert Villoria, PhD, MD, Servei Aparell Digestiu; Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, CIBERehd, Instituto de Salud Carlos III, Sabadell (Barcelona), Spain. Laura Moreno, RN, Infermeria, Hospital de Sabadell, Sabadell (Barcelona), Spain. Xavier Calvet, PhD, MD, Servei Aparell Digestiu;Hospital de Sabadell. Institut Universitari Parc Taulí. Universitat Autònoma de Barcelona. CIBERehd, Instituto de Salud Carlos III, Sabadell (Barcelona), Spain.
authors.forename: María
authors.initials: M
authors.lastname: López
authors.forename: Angelina
authors.initials: A
authors.lastname: Dosal
authors.forename: Albert
authors.initials: A
authors.lastname: Villoria
authors.forename: Laura
authors.initials: L
authors.lastname: Moreno
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001379:Azathioprine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D057184:Practice Patterns, Nurses'; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine