P0600Patient Initiated Follow Up: a modern strategy for mitigating outpatient demand in low risk IBD

Abstract Background The conventional outpatient model for all patients with IBD is to have at least one annual follow-up appointment. This may be superfluous if the clinical condition is stable and no changes required. The increasing prevalence and incidence of IBD mount pressure on outpatient services. The wait for a routine IBD appointment at our Trust is currently 12 months: inadequate for patients who require more active management. New models of care are therefore required. Patient initiated follow up (PIFU) can prioritise appointments to those most in need1. Stable patients are booked for surveillance endoscopy and virtual review of their notes but not offered routine appointments. The patient agrees to contact the service by emailing the IBD helpline (run by experienced IBD nurses with a 48-hour response time) if and when they need to be seen. Patients have a flare card to aid basic self management. PIFU trials have had good feedback from patients who feel they have more control over their illness2,3. The estimated cost of each appointment is £120: there may be cost savings too4. The aim of this study is to assess IBD related healthcare utilisation after a year of being on our new PIFU pathway. Methods From 2023, patients began moving to PIFU. The initial criteria were: UC in remission on mesalazine or no therapy. Data on patients on PIFU for a full year were collected (30/9/23–30/9/24). Contact to the service was recorded within a year of being placed on PIFU including: contact to the helpline, clinic appointments, unplanned endoscopy and hospital admission. Changes in therapy were recorded. They were analysed to ascertain the clinical contact on the pathway and outcomes assessed. Results On 30/9/25, 125 patients had been on PIFU for a year. Results are shown in figure 1. All surveillance was requested correctly. Conclusion The use of PIFU saved over 120 appointments in a year with a potential saving of £14400. Most patients did not contact the helpline. PIFU was safe with no IBD related admissions. No patients received systemic steroids (the caveat that some may obtain these from primary care). We did not collect patient feedback to ascertain satisfaction but there was only one complaint in this period. 14.4% of PIFU patients did not have a diagnosis of UC with many clinicians empowered to place other IBD clinic patients onto PIFU including patients with microscopic colitis, isolated terminal ileitis and Crohn’s colitis patients with a pan proctocolectomy with no small bowel disease. The next steps are to formally expand the PIFU pathway to these patients, collect outcome data and patient feedback including satisfaction and steroid use from elsewhere. PIFU may offer a safe and acceptable strategy to capacity restraints in busy IBD services. References: 1. England NHS. NHS England » Implementing patient initiated follow-up: guidance for local health and care systems. May 17, 2022. Accessed November 6, 2025. https://www.england.nhs.uk/publication/implementing-patient-initiated-follow-up-guidance-for-local-health-and-care-systems/ 2. Lewis RL, MacFaul G, Michie C, Sheppard A, Stone M. P81 Evaluation of the efficacy of digitally-enabled patient-initiated follow up (PIFU) pathways for ulcerative colitis, supporting patient self-management. Gut. 2024;73(Suppl 1):A98-A98. doi:10.1136/gutjnl-2024-BSG.163 3. Hewlett S, Kirwan J, Pollock J, et al. Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial. BMJ. 2005;330(7484):171. doi:10.1136/bmj.38265.493773.8F 4. Philpott-Morgan S, Thakrar DB, Symons J, Ray D, Ashrafian H, Darzi A. Characterising the nationwide burden and predictors of unkept outpatient appointments in the National Health Service in England: A cohort study using a machine learning approach. PLOS Med. 2021;18(10):e1003783. doi:10.1371/journal.pmed.1003783 Conflict of interest: Dr. Findlay, Ross: No conflict of interest Choon, Xin Yi: No conflict of interest Khan, Zara: No conflict of interest Nedungadi, Arya: No conflict of interest Anderson, Simon: No conflict of interest Dart, Robin: Grant: Takeda Personal fees: N/A&#xBConsulting: Tillotts, UCB&#xBSpeaker fees: Takeda, UCB&#xBEducational sponsorship: Galapagos, Takeda Gecse, Krisztina B.: Grant: Abbvie, Pfizer Inc, Celltrion and Galapagos/Alfasigma Personal Fees: Consultancy fees from AbbVie, ​Galapagos, Gilead, Immunic Therapeutics, Janssen Pharmaceuticals, Pfizer Inc., and Takeda and speaker’s honoraria from Celltrion, Eli Lilly, Janssen Pharmaceuticals, Pfizer Inc. and Takeda. Irving, Peter Miles: Grant: MSD, Pfizer, Takeda, Celltrion, Galapagos Personal Fees: AbbVie, Arena, BMS, Boomerang Medical, Celgene, Celltrion, Falk Pharma, Ferring, Galapagos, Genentech, Gilead, Hospira, Janssen, Lilly, MSD, Pfizer, Pharmacosmos, Prometheus, Roche, Sandoz, Samsung Bioepis, Sapphire Medical, Sandoz, Shire, Takeda, Tillotts, Topivert, VH2, Vifor Pharma, Warner Chilcott Samaan, Mark: Advisory fees: Janssen, Takeda, Sandoz, Samsung Bioepis, Galapagos, AbbVie, Pfizer, STADA, Bristol-Myers Squibb, MSD, Sanofi, Tillotts, MSD Lecture fees: Bristol-Myers Squibb, Janssen, Takeda, MSD, Falk, AbbVie, Galapagos, Lilly, Advanz Mawdsley, Joel: None Ray, Shuvra: No conflict of interest