Successful implementation of a nurse-led teaching programme to independently administer subcutaneous methotrexate in the community setting to children with Crohn's disease

Aliment Pharmacol Ther. 2009 Jan;29(1):90-6. doi: 10.1111/j.1365-2036.2008.03861.x. Epub 2008 Sep 30.


Background: Methotrexate is increasingly used as a third line immunosuppression agent in children with Crohn's disease (CD). Methotrexate is traditionally administered in the hospital setting.

Aim: To set up a nurse-led education programme to teach children/their parents to administer subcutaneous methotrexate in the community.

Methods: All patients were given methotrexate over a 16-month period. Patient demographics including previous treatments were collected. A competency based teaching package was implemented by the inflammatory bowel disease nurse. Distances and travel times together with costings were calculated.

Results: Thirty two patients (19 male; 13 female) with a median treatment age of 11.96 years (IQR 10.67-13.92) were studied. Thirty of 32 (17 children, 13 parents) were independently administering methotrexate. The median return journey distance to hospital was 23 miles (IQR 14.4-42.4) taking a median time of 52 min (IQR 41.0-73.5) for each injection. The total patient travel saving was £10,537 (average £730 per patient) and nursing time saving was £12,808 with home administration (total saving £23,345).

Conclusions: This paediatric study demonstrates that methotrexate injections can be given successfully in the majority (94%) of patients with CD independently in the community, resulting in significant time and money savings for patients and health professionals alike.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Crohn Disease / drug therapy*
  • Crohn Disease / economics
  • Female
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / economics
  • Injections, Subcutaneous / economics*
  • Injections, Subcutaneous / methods
  • Male
  • Methotrexate / administration & dosage*
  • Methotrexate / economics
  • Nurse Clinicians*
  • Parents / education
  • Residence Characteristics
  • Retrospective Studies
  • Scotland
  • Treatment Outcome


  • Immunosuppressive Agents
  • Methotrexate