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
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
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
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
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.
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.
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
Normal IBDoc results in IBD
patients 3 and 6 months following
initiation of anti-TNFα therapy.
No. of Appointments Not Needed
Clinics and colonoscopies saved
through patients using IBDoc
calprotectin home tests.
If clinics are
advice is - just