title: Changing face of care for patients with moderate to severe inflammatory bowel disease: the role of specialist nurses in the governance of anti-TNF prescribing.
abstract: BACKGROUND
  Anti-tumour necrosis factor (TNF) therapy is highly effective for inflammatory bowel disease (IBD), but expensive and potentially toxic. Meticulous supervision prior to and during anti-TNF treatment is required to screen and monitor patients for adverse clinical events. In addition, a systematic administrative process is necessary to comply with Australian Medicare requirements and ensure ongoing therapy is uninterrupted. IBD nurses are essential components of multidisciplinary IBD services, but their role in facilitating the safe and timely delivery of anti-TNF drugs is unacknowledged.
  
  
  OBJECTIVE
  The aim of the study was to calculate time spent by IBD nurses on anti-TNF drug governance and its indirect cost.
  
  
  METHODS
  Time spent on activities related to anti-TNF governance was retrospectively assessed by questionnaire among IBD nurses employed at Melbourne hospitals. The capacity of IBD clinics at these hospitals was separately evaluated by surveying medical heads of clinics.
  
  
  RESULTS
  On average, each Melbourne IBD service handled 150 existing and 40 new anti-TNF referrals in 2013. The average annual time spent by nurses supervising an existing and newly referred anti-TNF patient was 3.5 and 5.25 h respectively, or a minimum of two full working days per week. If clinicians undertook this activity during normal clinic time, the organisational opportunity cost was at least 58%.
  
  
  CONCLUSIONS
  Anti-TNF therapy governance is an essential quality component of IBD care that is associated with a definite, indirect cost for every patient treated. IBD nurses are best positioned to undertake this role, but an activity-based funding model is urgently required to resource this element of their work.
authors.affiliation: Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: W R
authors.initials: WR
authors.lastname: Connell
authors.affiliation: Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Samyue
authors.affiliation: Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: P R
authors.initials: PR
authors.lastname: Gibson
authors.affiliation: Gastroenterology, Western Health, Melbourne, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Lachal
authors.affiliation: Gastroenterology, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: G T
authors.initials: GT
authors.lastname: Moore
authors.affiliation: Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: F A
authors.initials: FA
authors.lastname: Macrae
authors.affiliation: Gastronterology, Eastern Health, Melbourne, Victoria, Australia.
authors.forename: D R
authors.initials: DR
authors.lastname: Van Langenberg
mesh_terms: D011307:Drug Prescriptions / Q000191:economics / Q000592:standards*; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000191:economics; D008297:Male; D009720:Nurse Clinicians / Q000191:economics / Q000639:trends*; D024802:Nurse's Role; D005791:Patient Care / Q000191:economics / Q000639:trends*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: IBD nurse; anti-TNF therapy; inflammatory bowel disease; multidisciplinary models of clinical care