A REVIEW OF GUIDED SELF MANAGEMENT FOR PATIENTS WITH ULCERATIVE PROCTITIS

ABSTRACT

Introduction With secondary care services transitioning into virtual and telephone consultations our aim was to minimise face to face routine appointments during the Covid 19 pandemic for patients with stable ulcerative proctitis. We assessed patient satisfaction of the guided self-management leaflet and whether this can be adopted long term for this patient group. Methods From our IBD database we identified all patients with a coded diagnosis of 'proctitis'. Clinical portal notes and previous colonoscopies were reviewed to ensure correct diagnosis. Only patients with stable disease - minimal contact with IBD nurses, no recent admissions, infrequent flares were included. Identified patients were sent a Guided Self-Management leaflet in the post and a follow-on response questionnaire was sent around 6 months later. For non-responders a second questionnaire and/or telephone was arranged. Results 37 Patients were identified. We received responses (via post, phone or email) from 28/37 patients (76%). 10/28 (36%) didn't receive or do not recall receiving the leaflet.18/ 28 received the leaflet (64%). of those who received the leaflet, 16/18 felt it was easy to understand and contained enough information to confidently manage their symptoms. 2 patients had 1 flare and 3 patients had more than 3 flares since receiving the leaflet. of those with flares 2 patients were able to self-manage their proctitis using the leaflet provided. 2 patients had to contact the IBD nurses. These patients were called back within 24 hours and received useful advice. One patient had forgotten to use the leaflet. No one required rescue steroids or admission to hospital. Overall, 17/18 (94%) felt the service was good or excellent compared to previous clinic review systems. Conculsions The above results suggest the Self Guided Management Leaflets in this low symptom burden proctitis group are safe and easy to use. Overall feedback of the leaflet was positive and allowed the vast majority of patients to selfmanage their symptoms without the input of the IBD nurses. The main limitations of this study were leaflet distribution and questionnaire response. Issues included wrong patient address, the leaflet being thrown away and patients forgetting to use it during a flare. We therefore suggest all patients identified have a Face-to-Face appointment at point of diagnosis or subsequently with an IBD nurse to issue and discuss leaflet. This will ensure each patient receives the leaflet and hopefully improve engagement with self-managing flares. We plan to repeat the survey in 6-12 months with a larger patient group.