P26 Standardising outpatient care for primary biliary cholangitis patients in a hospital trust

Published Date: 18th June 2023

Publication Authors: Zhang M, Fox M

Abstract

Introduction
Primary biliary cholangitis (PBC) is a progressive autoimmune mediated cholangiopathy. There are well recognised treatments for both the underlying disease and symptom control highlighted by British Society of Gastroenterology (BSG) guidelines. Anecdotally, clinical practice does not reflect this. One likely reason is that patients are seen in various clinics by a range of clinicians with differing expertise. We aim to implement a clinic proforma to improve and standardise care for PBC patients.

Methods
Undertaken in a single-centre, district general hospital, key performance indicators (KPIs) were devised based upon BSG guidelines. A local PBC database identified patients seen in clinic in the last two years and our KPIs were retrospectively applied. A clinic proforma was then implemented to trigger consideration of these KPIs and data was collected from all PBC patients seen in the following 10 months. Standard care was defined as 80% of clinics achieving each KPI.

Results
50 patients seen prior and 38 seen after the introduction of the proforma were included. 80.6% were female and 19.8% had cirrhosis. The mean age at diagnosis was 52.6 years. Overall, the percentage of KPIs achieved increased following introduction of the proforma (51.2% to 77.4%). Data for select KPIs are shown in table 1.

68.1% were seen by either hepatology consultants or nurses. They achieved a higher proportion of KPIs compared to general gastroenterology clinicians pre-proforma (55.5% vs 39.4%) and post-proforma (86.6% vs 62.9%). This was particularly evident when comparing KPIs regarding symptoms and Fibroscans. Additionally, one patient’s PBC diagnosis was removed after the proforma prompted its re-evaluation.

Conclusion:
The number of KPIs achieved increased with the introduction of the proforma. However, many KPIs remain below our 80% target for standard care. Liver specialists appear to achieve a higher number of KPIs, though we recognise that implementation of our proforma into already busy clinics is also a significant barrier. Going forward, we believe a specialist led PBC clinic and digitalisation of outpatient services, which could mandate the proforma’s use, are both viable solutions to further drive improvements in PBC care.

 

Zhang, M; Fox, M. (2023). P26 Standardising outpatient care for primary biliary cholangitis patients in a hospital trust. Gut. 72(Suppl 2), pp.A59-A60. [Online]. Available at: https://doi.org/10.1136/gutjnl-2023-BSG.99 [Accessed 15 December 2023]

 

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