P029 Overcoming delays in administration of biologics in rheumatology patients across Aneurin Bevan University Health Board, South Wales

Delays in initiation of biologic treatments in rheumatology patients can lead to inadequate disease control, poor patient satisfaction and potentially cause irreversible joint damage. Majority of biologic treatments in rheumatology patients are delivered via Homecare services and significant delays have been reported across UK. Timely and efficient provision of biologic treatment is imperative, in order to achieve appropriate disease control and improve patient outcomes. We assessed the factors leading to delays in biologics’ initiation and made appropriate interventions in order to improve timely provision of biologic treatments for rheumatology patients across Aneurin Bevan University Health Board, South Wales.

Clinical records of one hundred patients receiving biologic treatment were reviewed. Following plan-do-study-act cycle; timelines of steps in the process of biologic treatment delivery were calculated, starting from the consultant making the decision to commence biologic treatment followed by completion of pre-biologic screening after which the first prescription was forwarded to the pharmacy from where it was posted to homecare companies who delivered the medicines to patients. A significant delay in pre-biologic screening tests was identified and we recommended for all pre-biologic screening to be done in anticipation when a decision for biologic initiation was likely to be made soon. We shared the study results with our local pharmacy stakeholders and also recommended close liaison with homecare companies to expedite the processes at their end. Timelines were reassessed over four months post-intervention for all new cases. The demonstrated improvement was presented to the rheumatology directorate.

Reduction in the delay between clinical decision and commencement of biologic treatment from ten-twelve to seven weeks was demonstrated. Timely pre-biologic screening in advance of clinical decision of biologic initiation resulted in shortening the interval from clinical decision to completion of screening stage from five to three weeks. An improvement of a one week shortening was seen in the transit of the prescription through the hospital pharmacy. The last timeline in the process, which was from postal transfer of the prescription to the homecare companies to drug administration, was seen to be increased from three to four weeks. However, limited data was available regarding this last step as less than half of the cases had their first administration documentation uploaded to health records.

Early pre-biologic screening prior to initial clinical decision resulted in improved efficiency in the process of delivery of biologic therapies. Certain factors such as patient hesitation and screening test abnormalities can lead to inevitable delays. More robust data availability is needed to assess the delays related to the homecare companies. Task allocation to a team member in the companies to ensure data availability can result in a more accurate reflection, albeit at the cost of increased workload.

M. Rehman: None. E. Thomas: None. R. Asif: None.