James Turvill1, Shaun O'Connell2, Abigail Brooks3, Karen Bradley-Wood4, James Laing5, Swaminathan Thiagarajan6, David Hammond7, Daniel Turnock1, Alison Jones1, Ruchit Sood8, Alex Ford8. 1. 1York Hospital,York Teaching Hospital NHS Foundation Trust,York,UK. 2. 2GP Lead for Prescribing, Planned Care, Quality and Performance,NHS Vale of York Clinical Commissioning Group,York,UK. 3. 3Priory Medical Group,York,UK. 4. 4Posterngate Surgery,Selby,UK. 5. 5Pocklington Group Practice,Pocklington,UK. 6. 6Pickering Medical Practice,Pocklington,UK. 7. 7The Petergate Surgery,York,UK. 8. 8Leeds Institute of Biomedical and Clinical Sciences,Leeds University,Leeds,UK.
Abstract
BACKGROUND: National Institute for Health and Care Excellence have recommended faecal calprotectin (FC) testing as an option in adults with lower gastrointestinal symptoms for whom specialist investigations are being considered, if cancer is not suspected and it is used to support a diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome. York Hospital and Vale of York Clinical Commissioning Group have developed an evidence-based care pathway to support this recommendation for use in primary care. It incorporates a higher FC cut-off value, a 'traffic light' system for risk and a clinical management pathway. OBJECTIVES: To evaluate this care pathway. METHODS: The care pathway was introduced into five primary care practices for a period of six months and the clinical outcomes of patients were evaluated. Negative and positive predictive values (NPV and PPV) were calculated. GP feedback of the care pathway was obtained by means of a web-based survey. Comparator gastroenterology activity in a neighbouring trust was obtained. RESULTS: The care pathway for FC in primary care had a 97% NPV and a 40% PPV. This was better than GP clinical judgement alone and doubled the PPV compared with the standard FC cut-off (250 mcg/g and were diagnosed by 'straight to test' colonoscopy within three weeks. The care pathway was considered helpful by GPs and delivered a higher diagnostic yield after secondary care referral (21%) than the conventional comparator pathway (5%). CONCLUSIONS: A care pathway for the use of FC that incorporates a higher cut-off value, a 'traffic light' system for risk and supports clinical decision making can be achieved safely and effectively. It maintains the balance between a high NPV and an acceptable PPV. A modified care pathway for the use of FC in primary care is proposed.
BACKGROUND: National Institute for Health and Care Excellence have recommended faecal calprotectin (FC) testing as an option in adults with lower gastrointestinal symptoms for whom specialist investigations are being considered, if cancer is not suspected and it is used to support a diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome. York Hospital and Vale of York Clinical Commissioning Group have developed an evidence-based care pathway to support this recommendation for use in primary care. It incorporates a higher FC cut-off value, a 'traffic light' system for risk and a clinical management pathway. OBJECTIVES: To evaluate this care pathway. METHODS: The care pathway was introduced into five primary care practices for a period of six months and the clinical outcomes of patients were evaluated. Negative and positive predictive values (NPV and PPV) were calculated. GP feedback of the care pathway was obtained by means of a web-based survey. Comparator gastroenterology activity in a neighbouring trust was obtained. RESULTS: The care pathway for FC in primary care had a 97% NPV and a 40% PPV. This was better than GP clinical judgement alone and doubled the PPV compared with the standard FC cut-off (250 mcg/g and were diagnosed by 'straight to test' colonoscopy within three weeks. The care pathway was considered helpful by GPs and delivered a higher diagnostic yield after secondary care referral (21%) than the conventional comparator pathway (5%). CONCLUSIONS: A care pathway for the use of FC that incorporates a higher cut-off value, a 'traffic light' system for risk and supports clinical decision making can be achieved safely and effectively. It maintains the balance between a high NPV and an acceptable PPV. A modified care pathway for the use of FC in primary care is proposed.
Entities:
Keywords:
care pathway; faecal calprotectin; inflammatory bowel disease; irritable bowel syndrome; primary care
Authors: Christopher Andrew Lamb; Nicholas A Kennedy; Tim Raine; Philip Anthony Hendy; Philip J Smith; Jimmy K Limdi; Bu'Hussain Hayee; Miranda C E Lomer; Gareth C Parkes; Christian Selinger; Kevin J Barrett; R Justin Davies; Cathy Bennett; Stuart Gittens; Malcolm G Dunlop; Omar Faiz; Aileen Fraser; Vikki Garrick; Paul D Johnston; Miles Parkes; Jeremy Sanderson; Helen Terry; Daniel R Gaya; Tariq H Iqbal; Stuart A Taylor; Melissa Smith; Matthew Brookes; Richard Hansen; A Barney Hawthorne Journal: Gut Date: 2019-09-27 Impact factor: 23.059
Authors: Karoline Freeman; Brian H Willis; Ronan Ryan; Sian Taylor-Phillips; Aileen Clarke Journal: BMC Med Res Methodol Date: 2022-07-12 Impact factor: 4.612
Authors: James L Turvill; Daniel Turnock; Dan Cottingham; Monica Haritakis; Laura Jeffery; Annabelle Girdwood; Tom Hearfield; Alex Mitchell; Ada Keding Journal: Br J Gen Pract Date: 2021-07-29 Impact factor: 6.302
Authors: Corinne Chmiel; Oliver Senn; Susann Hasler; Thomas Rosemann; Gerhard Rogler; Nadine Zahnd; Ryan Tandjung; Nathalie Scherz; Michael Christian Sulz; Stephan Vavricka Journal: PLoS One Date: 2019-11-21 Impact factor: 3.240
Authors: Karoline Freeman; Ronan Ryan; Nicholas Parsons; Sian Taylor-Phillips; Brian H Willis; Aileen Clarke Journal: Br J Gen Pract Date: 2021-10-28 Impact factor: 5.386