Shared care & OTC approaches
Following the first three months of treatment with immunomodulators, GPs will be asked to share care with regards to patients’ medication supply and blood test monitoring. This means someone’s overall IBD care will still be managed by their hospital but, for patient convenience, medications recommended by secondary care will be supplied and monitored in primary care.
GP agreement is voluntary, with the right to decline shared care arrangements if for any reason the doctor does not feel confident in accepting clinical responsibility. Refusal should not be for financial reasons and the cost of the drug is not a barrier to sharing care either.
For patients who have their monitoring and supply of immunomodulators undertaken in the community, the frequency of blood tests should be at least every three months (sooner if doses are increased or adverse effects suspected).
It is important patients understand why blood tests are required and limiting prescriptions to three months’ supply will help ensure patients are being monitored appropriately. If monitoring is not taking place, it is safer to stop the medication.
OTC medicines
People with known IBD should be advised not to take antidiarrhoeals for a severe flare-up of their disease as this could lead to complications such as toxic megacolon and cause obstruction in patients with a stricture. Antispasmodics available over the counter (e.g. mebeverine, hyoscine butylbromide, alverine citrate) are normally recommended for people suffering with irritable bowel syndrome (IBS).
However, IBD patients may also experience IBS – so they may find it helpful to treat symptoms such as cramps and spasm with appropriate OTC products recommended by pharmacy teams.
NSAIDs in IBD
Inflammatory bowel disease sufferers are generally advised to avoid non-steroidal anti-inflammatory drugs (NSAIDs) where possible as standard doses have been found to cause a rise in disease activity scores. Low-dose NSAIDs and short-term use is acceptable in patients where IBD is well-controlled but the risk of flare could be higher if given to patients with active IBD.
Useful patient tools
Although IBD causes debilitating symptoms, patients are not considered ‘disabled’, so they sometimes worry they may be refused use of or confronted about accessible toilets. This can cause a lot of anxiety and even lead to patients avoiding going out. Crohn’s and Colitis UK (CCUK) has produced a ‘Can’t Wait’ card, which can be used to help people with IBD get access to toilets without embarrassment.
A RADAR key, sometimes called a National Key Scheme (NKS) key, is a large universal key used in the UK to open RADAR locks commonly installed in public accessible toilets such as disabled toilets. Having a RADAR key can mean quicker accessibility to a toilet. Patients who become a member of CCUK can apply for a free RADAR key or it can be purchased from Disability Rights UK.