Leading Edge 2021 Issue 2

4 LEADING EDGE - 2021-2 The mean calprotectin concentration, measured from the tests that were completed, was 509 µg/g. The IBDoc system is customisable to an individual patient level which enabled the hospital to apply its local cut-off values to the results (red/amber/green traffic light system) that were obtained: 0 - 250 µg/g = Normal 250 - 500 µg/g = Moderate >500 µg/g = High The categorisations of the results according to the local defined cut-off values were then as follows: These values then prompted the following actions based on the IBDoc: ■ 36.7% of patients required no change in management ■ 31.7% of patients had their management modified based on the IBDoc results and subsequent clinical correlation. ■ 31.7% required further assessment Following use of the IBDoc during COVID, a survey was sent out to the patients. From those who responded, 95% indicated that they would be willing/comfortable using the IBDoc in the future. 85% said they preferred it to the standard clinical attendance laboratory test, so patient acceptance was high. Most of the studies/publications available on patient self-testing have been based on the adult population. So, this was interesting feedback from a different set of patients who were aged from just under 5 years old to just over 18 years old. This very positive feedback is even more surprising because the patients did not get access to the numerical result or the traffic light indication in the App. This was the clinic’s choice to reduce anxiety with unsupported results but is normally the feature adults like best. COVID has caused many changes in our day to day lives, with freedom and services intermittently restricted as the infection rates surge and abate. This pattern has also been evident in our healthcare system as we have previously reported to you. A UK on-line survey in 2020 of 125 hospitals (Kennedy et al. Frontline Gastroenterology1) showed that 35% of hospitals reported all IBD related endoscopy had been cancelled, but most reported a significant reduction in availability. At the same time 27% of locations reported no access to faecal calprotectin whilst a further 32% reported reduced access. This was for a variety of reasons, including concerns over infectivity of COVID from stool samples, lack of access to cabinets for safe handling, increased workload from COVID, staff shortages in labs and calprotectin being defined as a non-critical assay by the RCPath, IBMS, ACP and ACB. This left many gastroenterologists without the critical tools they normally employed to manage their IBD patients. During this time, many hospitals implemented new systems to support their patients in a rather stressful time. Introducing IBDoc Calprotectin Patient Self-Testing The Royal Hospital for Children in Glasgow was one of the hospitals that introduced the IBDoc calprotectin patient self-test during this time. The team there has recently published a paper about their experience (Jere et al. BMJ2). From this publication we can see that the majority of patients who used the IBDoc were being routinely monitored or were being monitoring for response to a new therapy: Complementing Laboratory Calprotectin Monitoring with Patient Self-Testing The reasons listed for preferring the IBDoc home test over the traditional lab test were: University Hospitals Birmingham NHS Trust also implemented the IBDoc with some of their IBD patients recently, in response to COVID. In a recent poster from ECCO 2021, Edwards et al.3 presented an improved level of compliance with calprotectin testing using the IBDoc compared with the traditional laboratory method. This enables the clinical team to better support the patients appropriately: The majority of calprotectin testing will always be laboratory based tests for the differentiation of IBD from IBS. This is largely due to economic factors. However, customised patient monitoring and involvement for IBD positive patients, with remote tests and symptom checking, is becoming more widely adopted. Digital Technology NHSX is promoting digital technology to help improve patient pathways in a number of focus areas, and has recently published some digital playbooks for gastroenterology including the IBDoc (www.nhsx.nhs.uk/key-tools-and-info/ digital-playbooks/) Publications that show improved patient management and testing compliance, with quicker results, will help technology become more widely adopted as the normal standard of care. This should lead to rapid initiation of appropriate treatment plans, resulting in better patient outcomes as well as cost savings.