Find out more at www.calprotectin.co.uk/ibdoc 7 Initially we went through the formal training, but now we give the patients the kit and say watch the video and 9 out of 10 don’t have any issues with these instructions. Reduced Helpline Calls Since introducing IBDoc we get less calls on the helpline because patients can check themselves if they are concerned they are flaring. More than fifty percent of the time they do not have active disease – perhaps it is something they have eaten or they have a bug. Once they know it isn’t their disease then they don’t contact us. The other really big positive for us is the fast track clinic. We ask patients to do the IBDoc test before they come to clinic. When we have the calprotectin result readily available to make clinical decisions we can make a definite plan immediately. Previously they would have come to clinic and we would have been waiting 6-8 weeks for a result, so it is much more efficient for them to come in with their own result. During the two month period from February to March 2019, 27 patients who experienced symptoms of a flare-up did the IBDoc test and had normal results. Therefore they did not need to come to clinic. This is an example of considerable saving in terms of both financial cost to the hospital and also Gastroenterologist and IBD nurse time. Dr Elsafi from the Mercy conducted a study using IBDoc to indicate mucosal healing in IBD patients starting biologics1. Traditionally patients starting biologics have follow-up clinic appointments at 3 months and a colonoscopy at 6 months to assess mucosal healing. During the study 131 patients were provided with IBDoc kits, enabling them to test their own calprotectin levels at home at the 3 and 6 months post induction of biological agents. This avoided the need to attend hospital appointments to obtain a calprotectin result. Results from the IBDoc tests were transferred to the gastroenterology team’s database. At the 3 month assessments the IBDoc results showed that 40% of the patients had normal calprotectin levels. After 6 months 75% of the patients showed normal calprotectin levels [Figure 1]. Of the 78 patients that had a raised IBDoc calprotectin at 3 months, 28% of these had a normal reading after 6 months. Overall, using the IBDoc calprotectin results as indicators of mucosal healing, a total of 53 clinic visits and 62 colonoscopies were not required because the calprotectin results were within normal limits [Figure 2]. This represents a significant cost saving plus the benefits of better managed healthcare resources, reducing demand and therefore the waiting times for both clinic visits and colonoscopies, plus an improved patient experience. Guidance on Treatment Plans We also use IBDoc to guide decision making on switching treatments if a patient is on a biologic and isn’t doing so well from a symptom point of view. If the IBDoc result shows the calprotectin is high or continues to stay high then we would use this as justification to switch to another medication or for treatment escalation. Virtual Clinics At the Mercy we hold virtual clinics for patients who are in remission for at least six months and IBDoc is an essential component of being able to do this. The patients are sent an IBDoc kit in the post and an IBD questionnaire; they also get bloods done by their GP. A date is arranged for a call and we go through the results, ensure they are doing well and that no changes are required to the medication. After the call I dictate a letter to the GP to say they have been reviewed at a virtual clinic and outline what the outcomes are. Cost Savings We currently have more than 100 patients who are assessed on a virtual clinic basis. This is expected to increase as there are significant resource and cost savings using this approach. The cost of an outpatient clinic appointment in Ireland is €129.50 and that is without lab work or anything; with this level of saving it is definitely the way forward and the ability for remote testing is a key element of this. If clinics are considering implementing patient self-testing, my advice is - just do it. Talk to other clinics who have been using it and you will see very quickly how easy it is. The buy in from patients is very positive and overall it makes things easier from a healthcare point of view. Reference 1. G Elsafi. UEGW 2017. Cost effectiveness of IBDoc as a surrogate marker of mucosal healing in IBD patients post induction of biological agents. % of Patients with Normal IBDoc Calprotectin Levels Figure 1. Normal IBDoc results in IBD patients 3 and 6 months following initiation of anti-TNFα therapy. No. of Appointments Not Needed Figure 2. Clinics and colonoscopies saved through patients using IBDoc calprotectin home tests. If clinics are considering implementing patient selftesting, my advice is - just do it.
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