Cross-speciality collaborative care in complex immune-mediated inflammatory diseases: treating the person living with the condition.

BACKGROUND: Immune-mediated inflammatory diseases (IMIDs) are a wide group of autoimmune conditions that share common inflammatory pathways, meaning that people with one IMID are at elevated risk of developing another. People living with IMIDs are at increased risk of co-morbidities and quality of life (QOL) is negatively impacted. The economic cost of IMIDs is high both in terms of healthcare resource and lost productivity. In particular, there is significant unmet need in terms of clinical outcomes and patient satisfaction for people living with complex IMID (multiple IMIDs, co-morbidities and people for whom IMID(s) have a significant impact on QOL). MAIN BODY: Existing clinical service models focused on single specialty management provide fragmented care caught between individual specialities with delays to decisions and treatment plans, with individual IMID specialities competing for the same scarce National Health Service (NHS) resources. This siloed approach often focuses on suppressing inflammatory activity which may not adequately address the range of impacts on the person living with IMID. These issues have prompted a movement towards collaborative cross-specialty care. A collaborative cross-specialty approach has the potential for sharing knowledge and resources, to ensure timely referral and diagnosis, more effective use of available time for clinical consultation and early recognition and treatment of concomitant IMIDs. Compared with a traditional siloed model, a cross-specialty approach was associated with QOL theme benefits including positive patient experience and perceived disease control. Involvement of a cross-specialty team and well-defined referral criteria are key to optimal collaborative cross-specialty working. Existing initiatives have shown that relatively small changes to existing practice and cross-speciality collaborative working can result in bespoke solutions, such as parallel clinics, combined clinics and multidisciplinary team (MDT) sessions, face-to-face or virtually depending on the individual needs. A patient-centric framework, with individualised care, helps to address multimorbidity whilst improving physical and mental well-being. CONCLUSIONS: The development of a cross-specialty service for complex IMID cases has the potential to reduce the number and length of consultations, and available data indicate that such innovations may improve clinical outcomes, patient experience and quality of care in a cost-effective manner and suggest wider societal benefits.