Advancement in Care: Implementation of the Inflammatory Bowel Disease Navigation Program in Brazil

Background:
The inflammatory bowel disease (IBD) navigation program represents a significant advancement in the approach to these complex conditions. This study aims to report on the implementation of an IBD navigation program in a private IBD referral center in Brazil.
Methods:
This is a convergent care research study, conducted in 4 phases: situational diagnosis, planning, implementation, and evaluation, conducted from May 2024 to September 2024. Participants were 6 nurses and 3 physicians from a private IBD referral center in Rio de Janeiro, Brazil.
Results:
The majority of the nurses were female (n=4, 66.6%); and the mean age was 29.8 years; and 2 (33.3%) of these nurses have been working with IBD over 10 years. About the physicians, 2 were gastroenterologists and 1 was rheumatologist, both working with inflammatory diseases over 10 years. The nurses were classified by Advanced Nurse Practitioner (n=1, 16.7%), Clinical Nurse Specialists (n=2, 33.3%), Nurse Practitioners (n=3, 50%). In the first phase, a brainstorming was conducted to identify the challenges patients faced in accessing gastroenterologists and IBD nurses, and the most prevalent challenges were long waiting times to schedule appointments with gastroenterologists and lack of knowledge about appointments with IBD nurses. The program was planned using the PDSA tool (Plan, Do, Study, Act), and after brainstorming in the first phase, the action plan was carried out using the 5W2H methodology and indicators defined to monitor process improvement and the proposal. The nurses were trained and educated, gaining in-depth knowledge about the pathophysiology of the diseases, diagnosis, extraintestinal manifestations, treatments, diseases activity index, quality of life, anxiety and depression, sexuality, pregnancy, immunization, biological therapy, pharmacovigilance, incontinence, stoma, pediatric patients, advice lines, fecal calprotectin, fatigue, diet and nutrition. The total training hours were 24 hours. The epidemiological profile is composed of 395 patients with IBD, where 261 (66.08%) patients have Crohn’s disease, 129 (32.66%) with ulcerative colitis and 5 (1.26%) with indeterminate colitis, and due to the significant number of patients, it was not possible to include all of them in the action plan, however 276 (69.87%) patients were cared for by the IBD nurses in a humanized manner and meeting all the needs identified. After 2 months of evaluation, the program was deemed successful, as it met the goals set by the proposed indicators, such as reduction in time to schedule appointments, increase in demand for care with IBD Nurse, and patient satisfaction rate.
Conclusions:
The navigation program has shown positive results on several fronts. It is easy to apply and low-cost, which contributes to good adherence. Clinically, the program provides benefits such as quick access to specialists, early identification of flares, and improved treatment adherence. Additionally, it enhances the quality of life for patients with IBD, encourages empowerment and shared decision-making, and ensures more efficient, specialized, and individualized care.