Find out more at www.calprotectin.co.uk 9
Rapid Response
From my perspective I am seeing a difference
already, because we are able to escalate
treatment within a day or two of asking for
the calprotectin test to be done. We get the
result back immediately, whereas previously
there was a wait of around 4 – 6 weeks or
even longer depending on when the sample
was taken and the capacity in the labs.
Hopefully, in the future we will see the
benefits of this rapid response in terms
of reduced hospitalisations and clinic
visits, because patients have had timely
interventions. In addition there are reduced
calls to the helpline because we know the
results and are able to act quickly.
Cost Savings
Going forward we are hoping to be able to
reduce the clinic requirement for patients who
are stable, because we will be using all the
digital tools to remotely monitor and hopefully
reduce the risk of flare up. We will be altering
the natural history of the IBD which will be
the most powerful thing, but it will take a few
years to get the data to support this.
As part of the business case we estimated
some of the potential cost savings that may be
realised by introducing the technology.
Based on a relatively small population in one
area and then extrapolating up for the CCG,
the savings estimate was ~£330K. We know
we need further data to support this which
will take a few years to collect.
More Patient Engagement
The benefit of the IBDoc from the clinicians
perspective is obviously the speed with which
the result comes through. Personally I think
there is also more engagement both with
patients and within the clinical team, because
you are able to follow through on a course
of action quickly rather than waiting weeks in
between decisions which is more frustrating.
The IBDoc is very simple but with a lot of
impact on patient care.
IT Systems
Although the user interface is very simple
and straight forward, a big advantage for us
would be for the hospital IT system to pull
the IBDoc result into the Electronic Patient
Record. If this can be achieved then people
in all departments and primary care, can also
access the result which will help significantly.
I am hoping our hospital IT can organise this
for us, but COVID has made lots of additional
demands, so it may take some time.
Regional Adoption
The three trusts
in our region
(including Southend
and Broomfield)
amalgamated this year,
so we need to operate
the same pathways and
services in each of the
centres. At Basildon
we have driven the
adoption of the IBDoc
because we performed
the trial and have the
experience.
With the advent of
COVID the requirement
to operate more
remotely became
important, and so
this has helped with
the adoption in the other centres. We are all
operating from the same IBDoc portal, but
we have set it up so that we only see our own
patients.
The patients have a single support group now
and they do talk to each other (news travels
fast), so it would have been problematic
not to offer the same access to the new
technology.
Remote Monitoring
There is a move nationally towards more
remote monitoring because of the huge
demand for increased capacity, but by
relieving some of the resource requirements
we can create capacity. So, at the moment we
are continuing to operate virtual clinics that
were introduced during COVID and will do so
for the foreseeable future. There are benefits
not only for us but also for the patients in
not having to attend the hospital (and find a
parking space!).
With remote monitoring the virtual clinics
are ideal for those patients that are more
stable but who we still need to stay in touch
with. Before COVID we did do this for some
clinics, but I certainly see it expanding.The
IBDoc gives us the opportunity to monitor
the patients and have the ability to intervene
very early on if things start to progress so that
the patients don’t have to keep coming into
hospital. This ties in very much with the Topol
Review published in Feb 2019 which highly
recommended personalised care for long term
conditions and embraces national objectives
to adopt digital care. If we can implement this
then it will help us to operate more targeted
face to face clinics with the patients who have
more complex requirements.
Using the IBDoc has increased the
engagement from both the patients and the
clinical team, and the speed of the results
really makes a big impact in decision making
and patient management.
It doesn’t really add more work because you
save time in chasing results and additional
support for patients whilst they are waiting for
results.
The key things are:
■ Prompt result and treatment
■ Patient engagement in long term conditions
■ Personalised treatment”
Jacqueline Roscoe,
IBD Nurse Specialist
Jacqueline Roscoe is one of two full time IBD
nurses on the Basildon site, treating patients
from the surrounding areas that also include
Brentwood, Thurrock, Rayleigh and Purfleet.
“We treat adult patients and transitional
patients, so those that are 16 – 18 years of
age. For the transitional patients we have
a shared care system with the specialist
paediatric centres either at GOSH or
Addenbrookes.
Telephone Clinics
They operate two telephone clinics for
patients. Due to the COVID-19 pandemic
capacity in these has increased to around 20
patients a week. There is also a helpline for
patients taking around 10 calls and up to
50 emails a day. The nurses also run biologic
pre-assessment clinics every week. There is a
multidisciplinary team meeting (MDT) once
a fortnight and a video capsule endoscopy
service for when we want to take a closer look
at the small bowel.
In the initial comparisons of the IBDoc results
to the lab results most data compared
really well. For some results the values
were quite different, but when we spoke
to those patients we found that they were
only sampling from one place in the stool.
Once we explained they needed to sample
from several different places they got better
correlation.
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