8 PERSPECTIVE 2020 The recent merger of clinical services across Basildon, Southend and Broomfield, now forms the Mid and South Essex University Hospital Trust with a catchment population of 1.5 million. The Gastroenterology Department deals with the diagnosis and on-going management of patients with IBD. Patients who are diagnosed need regular monitoring in case of relapse/ flare, to ensure ongoing effectiveness of therapy and for funding and stopping of treatments. A helpline service is operated and patients calling this often require a calprotectin test to help to guide advice and treatment. The department introduced the BÜHLMANN IBDoc® calprotectin home test in early Summer 2020. Implementation has been a multidisciplinary team effort so we talked to some of the key team members about their focus on introducing new technologies to improve patient management. We also spoke to some of the patients, about their experience of using the test. Charlotte Williams, Director of Strategy “My role helps facilitate partnerships with pharma, industry and the supply chain to provide ideas, resources and intelligence that will improve the ways of operating within the NHS. Our focus in the innovation and transformation team is on supporting patient self-care and reducing unnecessary visits to hospital. Working with Dr Munuswamy we mapped the pathway and how the combination of the testing and the App interaction with the patient could achieve this. My role across the hospital group acted as the glue to bring the three clinical services together. Putting together the input from various discussions with different team members, a business case was developed to understand all the benefits and cost implications across the organisation. It was really when COVID hit that we thought about advancing the innovations. There was particular focus on those that had an impact on high risk populations where we could prevent the need to attend hospital and offer a better alternative. The IBDoc filled this requirement, and not just for the immediate crisis but it was something that we could sustain for the future as part of an existing strategy. We did a quick refresh of the documentation, a business case light approach and obviously it came out high on the impact assessment, not just during the COVID situation, but also with our future outpatient transformation programme. The Chief Finance Officer (CFO) was happy to support it, especially as the outlay has been minimal in terms of additional equipment and the nurses were quite committed to the opportunity of it too, so it wasn’t difficult to establish. The services rallied round fairly quickly to make it happen which is really to their credit. We are supporting clinicians to explore all the available options and ensure proposals are better than the current proposition. Having an executive champion within the organisation helps them get changes made without fighting through layers and layers of management.” Dr Pushpakaran Munuswamy Department Lead, Gastroenterology Recently I gave a talk to about 50 IBD patients at the support group, on digital health and how technology can improve and provide personalised patient care for their long term conditions. This was received very well and a number of the patients expressed an interest in the new technology for monitoring of their disease, because they could see the benefits of having patient participation and taking responsibility for their care. I did some investigating, came across Alpha Laboratories and IBDoc and we rapidly progressed to a pilot. I wanted to see if this was something that patients would like and accept, as this was a big change for them. We contacted patients to be signed up on the portal and trained on using the IBDoc test– we had about 20 patients participating in this. Laboratory Comparison The point of care team needed to establish how the IBDoc results correlate to the standard laboratory data. The calprotectin concentration is used to help make important decisions in the management of a patient so it is important that it is correct. We were conscious about making sure the lab ELISA and the IBDoc samples were at least taken on the same day. Consequently we only had 11 matched results, because of delayed samples sent to the lab, but there was no statistical difference in the results obtained (Spearman correlation was 0.795 and Pearsons correlation coefficient 0.673). Patient Acceptance Patients acceptance of the new test was almost 100% (although they were motivated patients who volunteered for the test). We now have ~ 110 patients signed up for the system and so far everyone has been really keen to try it. We haven’t had anyone refuse yet. The feedback is that patients really like the system, because of the quick result, rather than waiting weeks to find out, and they appreciate the personalised care. Obviously a big benefit for them is that we are allowing them to see the numerical results and the colour coding which is quite powerful for them in helping to understand their disease and providing reassurance. We have set the traffic lights to: <250 µg/g = Green 250 – 500 µg/g = Amber >500 µg/g = Red Digital Health - How Technology Can Improve and Provide Personalised Patient Care Mid and South Essex University Hospital Trust
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