The impact of introducing faecal calprotectin monitoring at home during the COVID-19 pandemic

Faecal calprotectin (FC) is a well-established biomarker to measure the level of inflammation in the gut. Assessment of calprotectin is important not only in forming a diagnosis of inflammatory bowel disease (IBD), but also in measuring disease activity, treatment effect, and predicting disease relapses.

Situation

Patients had to travel to Basildon hospital to provide a stool sample in order to obtain a calprotectin result. The sample would be sent for laboratory analysis, leading to delays of up to 6 weeks between sample collection and test result. This caused delays in initiation of specific treatment plans.

A significant proportion of patients with IBD would have to shield at periods during the pandemic, so an intervention to reduce trips to hospital wherever possible would be highly beneficial to this cohort of patients.

Aspiration

Mid and South Essex NHS Foundation Trust wanted to implement a solution that would enable patients to test their own calprotectin levels at home during the COVID-19 pandemic. This would allow patients to take an active role in monitoring their own disease while avoiding the need for a hospital appointment and delays in obtaining the calprotectin result of up to 6 weeks.

Solution and impact

The BÜHLMANN IBDoc solution was introduced in the summer of 2020 at the Basildon Hospital site.

The department’s IBD coordinator implemented a process of signing patients up on the IBD portal followed by sending them a link and step-by-step instructions on getting started with the test. The kits were then packaged up in a padded envelope and sent out to the patient, which worked well.

Patient interest and engagement was high. Around 110 patients voluntarily signed up for the system at Basildon Hospital by September 2020, accounting for around one third of the service’s biologic patients. By March 2021, 300 patients were signed up to use IBDoc across the Trust’s 3 sites.

Impact

Patient satisfaction and acceptance of the test has been almost 100%.

The app provides colour coding of results for the patient in a traffic light system to enable them to understand their disease. This has proved powerful for patients.

The speed of the result has a big impact on decision-making in relation to patient management. The department can escalate treatment within a day or two of asking for the calprotectin test to be done. They get the result back immediately, whereas previously there was a wait of around 4 to 6 weeks for lab analysis of samples.

The department receives fewer calls to the helpline. This saves work for staff who otherwise would be offering support to patients waiting for the test outcome while simultaneously chasing the calprotectin test result.

It is estimated that the technology could deliver a significant cost saving of around £330k per year to Basildon Hospital and its clinical commissioning group.

Implementing the solution has relieved resource requirements and created capacity so that the hospital can cope with an increased demand for IBD services.

Functionality

• IBDoc is a smartphone app which can reliably read a simple stool test to generate a calprotectin level at home. The test can provide a result in as little as 2 hours
• The app is available for iOS and Android
• Data from the app is uploaded to the IBDoc web portal where results can be viewed by healthcare professionals

Capabilities

• The patient is supplied with a login for the IBDoc portal
• The IBDoc technology guides the user through the steps of obtaining and testing a stool sample with the apparatus and cassette provided
• Once the steps have been followed the patient then scans the test cassette into the app which calculates a quantitative calprotectin concentration
• The result is generated into a traffic light code (indicating a normal, moderate or high result), giving the patient real-time information about the condition of inflammation in the gut
• The moment the patient saves the result to the app, the result is transferred to the IBDoc web portal. A push message then notifies the healthcare professional of the receipt of the result

Scope

This test can be used at home by patients to avoid trips to the hospital for routine monitoring, encouraging self-management and increasing medication compliance.

The web portal can be used by staff to review the test results provided by the app.

Key learning points

Due to the burden of the pandemic on the Trust's IT department, it took longer than was hoped to enable the IBDoc result to be shared in the hospital’s main electronic health system.

The IBDoc portal can be shared between different sites, which was done for the 3 hospitals in the region.

Initially there was a reasonable amount of work required in signing up patients for the first time, but once they were established on the portal the team just needed to send them a new kit each time they required a test.

An IBDoc video-based patient training proved very useful for patients.

Key figures/quotes

“IBDoc gives us the opportunity to monitor patients and the ability to intervene very early on to avoid disease progression, so that the patients don’t have to keep coming into hospital.”
Dr Pushpakaran Munuswamy, lead consultant gastroenterologist, Basildon Hospital

“I have had Crohn’s disease for 40 years. There is an enormous benefit in using IBDoc for long-term patients in the self-management of their condition. Results can be seen straight away without the inconvenience of having to go to the hospital and then waiting for results to be sent, and treatment plans can be established more quickly.”
Stephen Bonnington, Crohn’s disease patient managed by Basildon Hospital

Find out more

Read "How technology can improve and provide personalised patient care" (PDF, 3MB)

Read more about the use of IBDoc in Essex (PDF, 1.1MB)

More about the IBDoc calprotectin home test kit procedure

Key contact

Dr P. Munuswamy, gastroenterology department lead, Basildon Hospital

pushpakaran.munuswamy@nhs.net

Amanda Appleton, Alpha Laboratories Ltd

aappleton@alphalabs.co.uk