Dietary intervention is a suggested first-line approach for IBS in UK National Institute for Clinical Health and Excellence (NICE) guidance for IBS. However, dietetic services are required to deliver this intervention and services are struggling to cope with demand. Digital technology, such as pre-recorded, on-demand webinars, offers a means of delivering patient education for unlimited numbers of patients, enables self-care using expert advice and potentially releases time across the healthcare system. This study aimed to assess the feasibility, acceptability and cost efficiency of using webinars to deliver first-line advice to patients with suspected or newly-diagnosed IBS.
A single group pre-post study design was used to evaluate the feasibility, acceptability and cost efficiency of a first-line dietary advice webinar for IBS patients in primary care. Advice reflected the British Dietetic Association (BDA) guideline first-line advice for IBS. Health care professionals (HCPs) working in Somerset referred adults patients (>18 years and over) with IBS to a ‘IBS First Line Advice’ webinar. Individuals were invited to complete an anonymous survey before and after completion of the webinar.
Pre-recorded webinars were created and made available on-demand via the community dietetic departments website. The cost of webinar creation (including the subscription) was £3597. A variety of methods for promoting the webinar to local GPs and HCPs were employed. No referral letter was required.
Between 1st September 2017 and 15th April 2020, the webinar was viewed 2300 times with 1171 attendees accessing the pre-webinar survey and 443 the post-webinar survey. 68% of patients had been diagnosed with IBS by a HCP and of those completing the post-webinar survey most were registered with a Somerset GP. The majority of patients found the webinar easy to access, were satisfied with the content and would recommend it to a friend with IBS. Knowledge and confidence in managing their IBS symptoms increased following the webinar. Patient understanding of which HCP is most appropriate to seek help from in managing their symptoms changed following the webinar with a reduced reliance on GP and secondary care gastroenterology and an increased recognition of the role of a specialist dietitian. Patients were also asked if they would like to attend a low FODMAP webinar and 64% confirmed they would with a further 27% answering ‘maybe’. A comparison of number of dietetic referrals of IBS patients pre and post implementation of the first-line webinar showed a 44% reduction in referrals, representing a saving of dietetic time estimated to be £3593 per annum. This time saving allowed for provision of a service to patients with coeliac disease and inflammatory bowel disease (IBD) in remission.
This service evaluation has shown that the delivery of first-line dietary advice for IBS in the form of a webinar was feasible, acceptable and cost-effective. The cost of development and delivery of the webinar has been offset by the cost savings achieved. The most common reason for attending the webinar was ‘access to accurate and reliable information’ reflecting the trust of the patients in the information provided. The age range of patients accessing the webinar was between 18-74 years with 33% being aged 55-74 years. This indicates that age is not a barrier to use of technology and this is also supported by recent research. The on-demand nature of the webinar meant it could be accessed at any time and also repeatedly allowing consolidation of knowledge for self management. This was important and was cited as the second most common reason for accessing patient education in this format. However, limitations of this service evaluation included the anonymity of online data meaning it was not possible to cross match pre- and post-webinar survey responses. The data collection also does not include long-term follow-up of patients to determine if improvement in symptoms was seen following the webinar. There are also equity of access issues to consider including availability of webinars in other languages and for those with hearing or sight disabilities.
Care of IBS patients is an example of where dietitians can take on a role as a first contact practitioner (FCT) in order to reduce GP workload. More research is required to better assess the benefits, feasibility and challenges of implementing this technology at scale.
Williams M., Barclay Y., Harper L., Marchant C. Seamark L. & Hickson M. (2020) Feasibility, acceptability and cost efficiency of using webinars to deliver first-line patient education for people with Irritable Bowel Syndrome as part of a dietetic-led gastroenterology service in primary care. J Hum Nutr Diet. https://doi.org/10.1111/jhn.12799