Clinical Decision‐Making During Monitoring Episodes in Advanced Therapy Management for Inflammatory Bowel Disease: A National Nurse‐Led Service Evaluation

ABSTRACT Background and Aims Advanced therapies for inflammatory bowel disease (IBD) require structured monitoring to optimise efficacy and ensure patient safety. Treat‐to‐target frameworks support proactive biomarker and therapeutic drug monitoring (TDM), yet monitoring practice across UK services remains variable and incompletely described. This national, nurse‐led service evaluation aimed to characterise monitoring episodes, describe associations between monitoring strategy and clinical decision‐making and contextualise variation in practice across UK centres. Methods A multicentre retrospective service evaluation was conducted across NHS Trusts participating in the UK IBD Nurse Research Network. Monitoring episodes were captured consecutively over a 12‐week data collection period and classified as proactive (planned, protocol‐driven) or reactive (unscheduled, symptom‐ or contact‐triggered). The primary process outcome was treatment modification following monitoring. The association between monitoring type and treatment modification was assessed using chi‐square testing with phi coefficient and odds ratio. Duration‐group analyses were reported descriptively using absolute percentage differences. As a service evaluation, findings describe practice patterns and associations rather than causal or inferential conclusions. Results A total of 236 monitoring episodes were analysed across 15 sites. Monitoring was proactive in 61.9% and reactive in 38.1% of cases. Treatment modification occurred in 37.0% of proactive and 71.1% of reactive episodes (absolute difference 34.1 percentage points; χ 2 (1) = 25.93, p < 0.001; ϕ = 0.33; OR 4.19, 95% CI 2.39–7.34). The most common drivers of modification were loss or non‐response (38.7%), faecal calprotectin result (35.3%), TDM result (21.8%) and safety or adverse events (21.0%). TDM completion was substantially higher early in therapy (78% at 0–3 months vs. 25% after 10 years). Adverse effect‐related and calprotectin‐guided changes showed no meaningful variation across duration groups (absolute differences 3 and 5 percentage points, respectively). Substantial variation in monitoring frequency, pre‐treatment screening and access to advanced therapies was observed across centres. Conclusions Reactive, flare‐driven monitoring was associated with higher rates of treatment modification, reflecting the burden of unplanned care in routine IBD practice. The decline in TDM completion with increasing treatment duration warrants attention. These findings support development of structured proactive monitoring pathways and highlight the value of nurse‐led collaborative evaluation in generating real‐world service evidence. Findings are descriptive and should not be interpreted as demonstrating the superiority of either monitoring strategy for patient outcomes.