PATIENT CARE
between 30 - 1000µg/g); A red, amber, green traffic light system with individually defined cut-off values; A ‘Test completed’ message with no indication of the result which is useful for blinding studies or when patients need more support with the results; The threshold levels for the traffic lights are customisable to individual patients – low when in remission or higher when severe and active
l The frequency of testing can also be adjusted depending on the severity of the condition. A message is sent to patients reminding them that a test is due.
With individual customisation available, the IBDoc is designed to provide flexibility. Testing can be tailored to provide results to support clinical decision making in a range of different scenarios through remote and more frequent patient monitoring. This enhances management without requiring additional resource, and, according to Elsafi et al, the requirement for clinic appointments and colonoscopies could be reduced.3 Although the number of laboratories offering calprotectin testing has increased significantly in recent years, many still perform the test in batches once a week, in
Since publication of NICE guidance DG11 in 2013, supporting the use of calprotectin as a cost effective method to differentiate between IBD and IBS, the rates of calprotectin testing in the UK have increased dramatically.
order to ensure cost effective use of reagents. In smaller institutions testing is often not
performed in-house, but is sent to a reference service with results taking upwards of two weeks to be returned. This delay can mean that treatment decisions have to be made without the support of the calprotectin result, or more invasive tests are performed to ultimately get the same indication.
Same day results
Patient self-testing in these situations provides same day results which can improve disease management and treatment plans, without the need for additional pathology resource. It also relieves patient anxiety, which otherwise can often have a negative effect on their condition.
The explosion of the mobile technology market means that healthcare based Apps are highly accessible as most people these days have a mobile device or tablet. This also reflects changes in lifestyle, with significantly more travel undertaken for business and foreign holiday destinations becoming ever more popular.
The Apps are able to transmit results back to a local portal enabling patients to stay in touch with their healthcare providers wherever they are. This helps ensure continuity of care/treatment, should things deteriorate and gives reassurance for patients to travel and ‘get on with their lives’ due to the support the Apps provide. These same benefits can also be used for people living in remote locations eg: the Scottish Highland and Islands where a routine clinic visit or even a laboratory test to help determine acute symptoms is logistically difficult and expensive to achieve.
Privacy for patients The calprotectin test result is read using the CalApp on the patient’s mobile phone.
One of the big advantages of patient self- testing, especially in the gastroenterology arena, is privacy. Generally people are embarrassed to take stool samples to the laboratory for testing and non-compliance is often high. This is a shame, as calprotectin is well documented to give a better indication regarding the health of the mucosa, having a higher correlation to endoscopic and histological findings than patient scores. The calprotectin result helps to make sense of symptoms and guide treatment decisions.
Being able to perform the calprotectin assay in the privacy of their own home seems to be well accepted by patients with studies quoting between 85-100% satisfaction/preference4,5 in testing, compared to routine laboratory tests. Although it obviously won’t be for
everyone, App technology is generally perceived as fairly progressive by patients and so they have the potential to enhance engagement in their disease management. Engaged patients are more likely to adhere to treatment plans, which hopefully prevents illnesses from deteriorating, preventing
the need for more costly or invasive care.
The result is displayed on the phone, automatically transferred to the IBDoc Portal and the patient’s doctor is immediately notified. Depending on the test result the doctor can communicate with the patient to advise on further therapeutic steps to be taken.
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Unfortunately deterioration can still occur even when treatment plans are followed, but remote monitoring can assist through prompt detection, enabling intervention at an earlier point than standard testing might otherwise permit.
SEPTEMBER 2018
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