Stammers Matthew, Rahmany Sohail, Downey Louise, Borca Florina, Harris Clare, Harris Richard, McDonnell Martin, Sartain Stephanie, Coleman Nicolas, Stacey Bernard, Smith Trevor R, Cummings Fraser, Felwick Richard, Gwiggner Markus
Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Clinical Informatics Research Unit, University of Southampton, Southampton, UK.
Frontline Gastroenterol. 2022 Mar 8;13(6):477-483. doi: 10.1136/flgastro-2021-102047. eCollection 2022.
Patients with suspected inflammatory bowel disease (IBD) referred from primary care often face diagnostic and treatment delays. This study aimed to compare a novel direct-access IBD endoscopy pathway with the traditional care model.
Single centre real-world study analysing primary care referrals with suspected IBD. Group A: patients triaged to direct-access IBD endoscopy. Group B: patients undergoing traditional outpatient appointments before the availability of direct-access IBD endoscopy. Demographics, fecal calprotectin (FCP), C-reactive protein (CRP), disease activity score, endoscopy findings, treatment and follow-up were collected and statistically analysed. Ranked semantic analysis of IBD symptoms contained within referral letters was performed.
Referral letters did not differ significantly in Groups A and B. Demographic data, FCP and CRP values were similar. Referral to treatment time (RTT) at the time of IBD endoscopy was reduced from 177 days (Group B) to 24 days (Group A) (p<0.0001). Diagnostic yield of IBD was 35.6% (Group B) versus 62.0% (Group A) (p=0.0003). 89.2% of patients underwent colonoscopy in Group B versus 46.4% in Group A. DNA rates were similar in both groups. The direct to IBD endoscopy pathway saved 100% of initial IBD consultant clinics with a 2.5-fold increase in IBD nurse-led follow-up.
Our novel pathway resulted in an 86% reduction in RTT with associated increased diagnostic yield while saving 100% of initial IBD consultant outpatient appointments. Replication in other trusts may improve patient experience and accelerate time to diagnosis/treatment while optimising the use of healthcare resources.
从基层医疗转诊而来的疑似炎症性肠病（IBD）患者常常面临诊断和治疗延迟的问题。本研究旨在比较一种新型的直接接入式IBD内镜检查途径与传统护理模式。
一项单中心真实世界研究，分析基层医疗转诊的疑似IBD患者。A组：分流至直接接入式IBD内镜检查的患者。B组：在直接接入式IBD内镜检查可用之前接受传统门诊预约的患者。收集人口统计学数据、粪便钙卫蛋白（FCP）、C反应蛋白（CRP）、疾病活动评分、内镜检查结果、治疗及随访情况，并进行统计分析。对转诊信中包含的IBD症状进行排序语义分析。
A组和B组的转诊信无显著差异。人口统计学数据、FCP和CRP值相似。IBD内镜检查时的转诊至治疗时间（RTT）从177天（B组）缩短至24天（A组）（p<0.0001）。IBD的诊断率为35.6%（B组）对62.0%（A组）（p=0.0003）。B组89.2%的患者接受了结肠镜检查，而A组为46.4%。两组的DNA检测率相似。直接接入IBD内镜检查途径节省了100%的首次IBD专科门诊，IBD护士主导的随访增加了2.5倍。
我们的新型途径使RTT降低了86%，同时提高了诊断率，还节省了100%的首次IBD专科门诊预约。在其他信托机构推广可能会改善患者体验，加快诊断/治疗时间，同时优化医疗资源的利用。
