The impact of a Virtual Biologics Clinic (VBC) on patient experience, research recruitment, and drug budget: a Quality Improvement Project.
Biologic therapy refers to the use of genetically engineered proteins derived from human genes for the treatment of inflammation.
Unlike traditional medicines for Rheumatoid Arthritis (RA), which affect the immune system in a broad way, biologics are designed to target specific areas of the immune system.
They are used to treat RA when a patient has not responded as hoped to traditional medicines and are integral to the modern management of rheumatic diseases. However, they represent a significant financial cost to the NHS and the healthcare economy and their increasing use has put existing biologics prescribing services under increasing strain.
As part of the MAHSC Improvement Science for Academics (IS4AC) programme, a Quality Improvement (QI) Project was therefore initiated in the Kellgren Centre for Rheumatology, Central Manchester University Hospitals Foundation Trust to establish a Virtual Biologics Clinic (VBC) to improve the biologics service and implement a Greater Manchester pathway for biologic prescribing in RA.
QI methodology was employed to understand processes and identify barriers in the current system and new systems of drug initiation were developed. All patients starting a biologic were assessed ‘virtually’ by a Rheumatologist, Specialist Nurse, Specialist Pharmacist and Research Nurse within the VBC. Pathway adherence, safety screening, and research study eligibility were reviewed in the VBC, and outcome data were collected weekly. The VBC was implemented in August 2013.
Use of the enhanced safety checklist increased from 50% to 100% within three weeks and median treatment delay fell from 41 days to 19 days within three months. Recruitment into research studies increased from 60 patients in 2012-13, to over 100 patients so far in 2013-14. Estimated annual cost savings to date (Feb 2014), attributed to pathway adherence and enhanced research recruitment, is estimated at £113,000.