GASTROENTEROLOGY
Colitis and Crohn’s Disease patients to test their own fCAL levels in the comfort and safety of their own homes. It uses smartphone technology to read the test results and transfer the data to their clinician. This frees up valuable resource and minimises contact. Being individually customisable by patient, testing can be tailored to provide results to support clinical decision making. With IBDoc, patients can test and read their own calprotectin levels in the privacy and safety of home. The IBDoc produces a quantitative result which is quickly and securely transmitted to the clinic for immediate access by the clinical teams enabling continued monitoring of patients and giving a good indication on the health of the gut.
NICE Medtech innovation briefing on home faecal calprotectin tests The NICE Medtech innovation briefing 132, published in December 2017, ‘POC and home test for calprotectin in monitoring IBD patients receiving treatment’, states that: “The evidence suggests that point-of-care and home-use faecal calprotectin tests have comparable accuracy to laboratory ELISA tests, but with better patient satisfaction”. IBDoc has been introduced across numerous Trusts, during the last year, to monitor vulnerable IBD patients. It gives faster results with the ability to intervene early if the disease starts to progress, enabling personalised care, while improving the patient experience and reducing costs. Patients have been accepting of the home testing and the benefits of doing the test themselves, in the privacy of their own home, without the risk of going into clinics. To use IBDoc, patients download the CalApp to their smartphone. This enables results of the calprotectin home test to be read, recorded, and transmitted to their clinician. With the support of telephone or video consultations and triage helplines, their care is being well maintained within limited resources. Using IBDoc for virtual clinics is central to facilitating a fast-track system which results in better outcomes for patients and improved allocation of resources that reduces cost, creates capacity, and keeps vulnerable people out of hospital.19 Both FIT and fCAL have been implemented more widely than pre-COVID-19, due to their value in triaging patients prior to diagnosis, without endoscopy and (in the case of fCAL) long-term patient management. Both tests have options for ‘contact-free’
sampling, either through sampling kits (FIT) or the IBDoc (fCAL) – helping to keep people away from hospital settings and therefore reducing the risk of further spreading the virus. The use of the patient-based sampling kits with FIT is novel and has proven highly efficacious in many settings. IBDoc expands
AUGUST 2021
on this further, by offering a complete at-home testing kit, which brings digital technology to the forefront of remote patient management. Both FIT and fCAL have, and will continue, to help improve hospital efficiency for long after the COVID-19 pandemic.
CSJ
References 1 Colorectal Cancer Survival by Stage - NCIN Data Briefing.
http://www.ncin.org.uk/publications/data_ briefings/colorectal_cancer_survival_by_stage (Accessed 19 March 2021).
2 Ho KMA, Banerjee A, Lawler M, Rutter MD, Lovat LB. Predicting endoscopic activity recovery in England after COVID-19: a national analysis. Lancet Gastroenterol Hepatol 2021 Mar 10:S2468-1253(21)00058-3. doi: 10.1016/S2468- 1253(21)00058-3. Epub ahead of print.
3 British Society of Gastroenterology. 2020. Endoscopy activity and COVID-19: BSG and JAG guidance – update.
www.bsg.org.uk/covid-19- advice/endoscopy-activityand-covid-19-bsg-and- jag-guidance/
4 Rutter, M.D., Brookes, M., Lee, T.J., et al.2020. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: A National Endoscopy Database Analysis. doi: 10.1136/gutjnl-2020-3221795.
5 Arasaradnam, R.P., Bhala, N., Evans, C., et al. 2020. Faecal immunohistochemical testing in the COVID-19 era: balancing risk and costs. The Lancet. Gastroenterology & Hepatology; 5(8), 717–719
6 Digby J, Strachan JA, McCann R, Steele RJ, Fraser CG, Mowat C. Measurement of faecal haemoglobin with a faecal immunochemical test can assist in defining which patients attending primary care with rectal bleeding require urgent referral. Ann Clin Biochem 2020;57:325-7. doi: 10.1177/0004563220935622
7 D’Souza N, Georgiou Delisle T, Chen M, Benton S, Abulafi M; NICE FIT Steering Group. Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study. Gut 2020 Oct 21:gutjnl-2020-321956. doi: 10.1136/ gutjnl-2020-321956. Epub ahead of print.
8 Mowat C, Digby J, Strachan JA, McCann RK, Carey FA, Fraser CG, Steele RJ. Faecal haemoglobin concentration thresholds for reassurance and urgent investigation for colorectal cancer based on a faecal immunochemical test in symptomatic patients in primary care. Ann Clin Biochem 2021 Jan 21:4563220985547. doi: 10.1177/0004563220985547. Epub ahead of print.
9 D’Souza, N. and Abulafi, M. 2020. Navigating the storm of COVID-19 for patients with suspected bowel cancer. Br J Surg;107(7): e204. doi:10.1002/ bjs.11695
10 Scottish Government. July 2020. Guidance for the use of FIT in the prioritisation of patients with colorectal symptoms now and in the recovery period after COVID.. Version 1.0.
www.gov.scot/ publications/ coronavirus-covid-19-guidance-for-useof-fit-testing- for-patients-with-colorectal-symptoms.
11
https://www.health.org.uk/news-and-comment/ WWW.CLINICALSERVICESJOURNAL.COM l 81
charts-and-infographics/non-covid-19-nhs-care- during-the-pandemic (Accessed 19 March 2021).
12 Strachan JA, Mowat C. The use of faecal haemoglobin in deciding which patients presenting to primary care require further investigation (and how quickly) – the FIT approach. eJIFCC 2021;32:52-60.
https://www.ifcc.org/ media/478839/ejifcc2021vol32no1pp052-060.pdf (Accessed 19 March 2021).
13 Moniuszko, et al. Rapid fecal calprotectin test for prediction of mucosal inflammation in ulcerative colitis and Crohn disease: a prospective cohort study. Pol Arch Intern Med. 2017 May 31;127(5):312-318. doi: 10.20452/pamw.4009. Epub 2017 Apr 26.
14 Derwa et al. Factors affecting clinical decision- making in inflammatory bowel disease and the role of point-of-care calprotectin. Therap Adv Gastroenterol. 2018 Jan 8;11:1756283X17744739. doi: 10.1177/1756283X17744739.
15 Views of patients with inflammatory bowel disease on the COVID-19 pandemic: a global survey. July 2020
www.thelancet.com/pdfs/journals/langas/ PIIS2468-1253(20)30151-5.pdf
16 Kennedy NA, et al. Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic. Frontline Gastroenterology 2020;0:1–8. doi:10.1136/ flgastro-2020-101520
17 Lees CW et al. Innovation in Inflammatory Bowel Disease Care During the COVID-19 Pandemic: Results of a Global Telemedicine Survey by the International Organization for the Study of Inflammatory Bowel Disease, Gastro Journal, May 28, 2020,
www.gastrojournal.org/article/S0016- 5085(20)34735-1/fulltext
18 Segal JP, Moss AC. Implications of recurrent SARSCoV-2 outbreaks for IBD management, Frontline Gastroenterology. 2020;0:1–6. doi:10.1136/flgastro-2020-101531
19 Sugrue et al. An evaluation of the impact of IBDoc in clinical practice 5 years after introduction. Poster ECCO 2020
About the authors
Emma Isom recently graduated from the Open University (BSc (Hons) Nat. Sci. Biology) and has been managing the FIT product range for three years; helping develop and implement the FIT-KITs in Primary and Secondary Care. Amanda Appleton has a BSc and MSc in Biomedical Sciences and for over six years has managed Alpha Laboratories’ extensive calprotectin portfolio. In that time, she has supported laboratories through technology changes and clinics in the introduction of the patient self-testing system. To find out more about calprotectin testing, visit: www.
calprotectin.co.uk or www.faecal-
immunochemicaltest.co.uk
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