Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/23132
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dc.contributor.authorSrinivasan, Ashish-
dc.contributor.authorvan Langenberg, Daniel R-
dc.contributor.authorLittle, Robert D-
dc.contributor.authorSparrow, Miles P-
dc.contributor.authorDe Cruz, Peter P-
dc.contributor.authorWard, Mark G-
dc.date2020-05-07-
dc.date.accessioned2020-05-12T07:04:55Z-
dc.date.available2020-05-12T07:04:55Z-
dc.date.issued2020-06-
dc.identifier.citationAlimentary Pharmacology & Therapeutics 2020; 51(12): 1342-1352en_US
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/23132-
dc.description.abstractVirtual clinics represent a novel model of care in inflammatory bowel disease. Their effectiveness in promoting high quality use of biologic therapy and facilitating a treat-to-target approach is unknown. To evaluate clinical and process-driven outcomes in a virtual clinic compared to standard outpatient care amongst patients receiving intensified anti-TNF therapy for secondary loss of response. We performed a retrospective multi-centre, parallel, observational cohort study of Crohn's disease patients receiving intensified anti-TNF therapy for secondary loss of response. Objective assessments of disease activity and anti-TNF trough levels at secondary loss of response and during subsequent 6-month semesters, were compared longitudinally between virtual clinic and standard outpatient care cohorts. The primary endpoint was treatment success, with appropriateness of dose intensification, tight disease monitoring and treatment de-escalation representing secondary outcomes. Of 149 patients with similar baseline characteristics, 69 were managed via a virtual clinic and 80 via standard outpatient care. There were higher rates of treatment success in the virtual clinic cohort (60.9 vs 35.0%, P < 0.002). Rates of appropriate dose intensification (82.6% vs 40.0%, P < 0.001), biomarker remission (faecal calprotectin P = 0.002), tight-disease monitoring (84.1% vs 28.8%, P < 0.001) and treatment de-escalation (21.3% vs 10.0%, P = 0.027) also favoured the virtual clinic cohort. This study favoured a virtual clinic-led model-of-care over standard outpatient care in facilitating treatment success as part of an effective treat-to-target approach in Crohn's disease. A virtual clinic model-of-care also improved treatment outcomes and quality of use of intensified anti-TNF therapy through processes that promoted appropriate dose intensification and tight-disease monitoring, while encouraging more frequent dose de-escalation.en_US
dc.language.isoeng-
dc.titleA virtual clinic increases anti-TNF dose intensification success via a treat-to-target approach compared with standard outpatient care in Crohn's disease.en_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleAlimentary Pharmacology & Therapeuticsen_US
dc.identifier.affiliationDepartment of Gastroenterology, Eastern Health, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of Medicine, Monash University, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of Gastroenterology, Alfred Health, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of Medicine, The University of Melbourne, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationGastroenterology and Hepatologyen_US
dc.identifier.doi10.1111/apt.15742en_US
dc.type.contentTexten_US
dc.identifier.orcid0000-0001-5952-1570en_US
dc.identifier.orcid0000-0003-3662-6307en_US
dc.identifier.orcid0000-0002-2840-0108en_US
dc.identifier.orcid0000-0002-3399-7236en_US
dc.identifier.pubmedid32379358-
dc.type.austinJournal Article-
local.name.researcherDe Cruz, Peter P
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
item.fulltextNo Fulltext-
item.grantfulltextnone-
item.languageiso639-1en-
item.openairetypeJournal Article-
crisitem.author.deptGastroenterology and Hepatology-
crisitem.author.deptGastroenterology and Hepatology-
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