Find out more at www.alphalabs.co.uk/FIT 5 Patient presents at GP with abdominal symptoms Patients triaged based on risk factors POSITIVE Refer for urgent colonoscopy NEGATIVE FAECAL IMMUNOCHEMICAL TEST for Hb SUSPECTED COLORECTAL CANCER Calprotectin test POSITIVE Refer for colonoscopy TIN TEST IBS/IBD Anti-TNFα: serum drug level and anti-drug antibody monitoring Confirmed IBD: Monitoring Therapeutic effectiveness But, what about the negative FIT results? They may still need to be considered further and, depending on the clinical symptoms, there is possibly a case for following up these patients in 6 to12 months time with another FIT test. Matthew: How did you manage to secure funding for a new test? Ian: At present, the funding still isn’t guaranteed and there is an on-going discussion as to where resources will come from. The NHS Board has indicated that the funding required could be moved from the endoscopy budget through into the laboratory budget. However, this becomes a bit of a grey area in that the test is actually being offered to patients seen in primary care, but the results are going back to secondary care, so it becomes part of the referral process for lower GI endoscopy. Matthew: How did you work with the community GPs to implement the new test service? Ian: We’ve engaged with a limited number of GP practices to start with and, over the next few months, we are starting to review how we actually provide this service and then fine- tune it. We’ve gone out and met with these practices and educated them, discussing how we are going to accept referrals for patients that present with lower GI symptoms. We explain that they would normally have been referred for a lower GI endoscopy but now they will first be provided with patient FIT collection kits, pre-paid envelopes and patient instructions for collection of faecal samples. So, the idea is that all referrals are done through an electronic mechanism for referral. At the time of referral in primary care, the patient is given an easy to use, hygienic, HM-JACKarc specimen collection device and asked to collect their sample and return it, with the laboratory request form, which identifies them, in the prepaid envelope provided. They’re told to do that immediately, with their next bowel motion, and send it off as soon as possible. All the devices go back to a central hub, here in Monklands Hospital in Airdrie. We can’t be seen as a delaying factor in triage. The endoscopy team receives the electronic referral, and they know to expect the f-Hb concentration result, therefore there’s a time window which is currently being fine-tuned for us to return a FIT result. Based on the FIT result, they may choose to fast track that patient straight to colonoscopy. There is then the potential to avoid expensive, unpleasant and potentially risky colonoscopies where they are not necessary. Pretty much every GP we’ve spoken with, to date, thinks this is a useful addition to the health service. Remember, at present, they don’t have gFOBT, and currently the only option for patients with lower GI symptoms is to offer a referral for colonoscopy. Sometimes the patients' symptoms have resolved by the time they receive an appointment. Others are put on a long waiting list. Both the patient and the GP can now feel that something is being done at an earlier stage. Patient feedback will be surveyed once this approach is rolled out to a higher number of GPs. However, there is the potential for this not to work! There are over 100 general practices in NHS Lanarkshire and, when FIT kits were sent out during the pilot project, there was only a 50-60% return rate, so we really want to ensure we have full engagement with the GPs and patients before rolling it out any further. We would like to engage more with general practices first, to ensure they are fully briefed to gain maximum participation from the patients, before rolling it out to all of NHS Lanarkshire. Matthew: What were the outcomes from the new test implementation? Ian: The lessons to be learnt are to engage with all parties concerned, maybe forming a group to discuss the patient pathway and implementation involving the laboratories, GPs, GI surgeons and Gastroenterologists, as well as the endoscopy services. Impacting Abdominal Pain Patient Pathways Through Diagnostics
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