scholarly journals Audit of the impact of the York faecal calprotectin care pathway on colonoscopy activity

2019 ◽  
Vol 11 (4) ◽  
pp. 285-289
Author(s):  
James Turvill ◽  
Daniel Turnock
Keyword(s):  
Primary Care ◽  
Care Pathway ◽  
Teaching Hospitals ◽  
Colonic Disease ◽  
Faecal Calprotectin ◽  
Number Of Patients ◽  
Time To Diagnosis ◽  
Clinical Diagnoses ◽  
Irritable Bowel ◽  
The Impact

BackgroundThe York faecal calprotectin care pathway (YFCCP) was developed to optimise effective primary care differentiation between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). We undertook an audit of colonoscopy activity at York Teaching Hospitals after the introduction of the YFCCP, to assess its impact.MethodsFaecal calprotectin (FC) results were reconciled with colonoscopy activity in patients 18–60 years after the implementation of the YFCCP. This permitted individual patient tracking of their FC values, the timing of those requests by primary care, the date of subsequent referral and investigation and the end clinical diagnoses.ResultsPrimary care uptake of FC increased fourfold with the introduction of the YFCCP. Following implementation, FC-related referrals for colonoscopy fell from 24% to 13%. The number of patients needed to colonoscope to diagnose organic colonic disease (IBD, significant adenomatous polyps or colorectal cancer) fell from 6.8 to 3.8 when the YFCCP was applied. This represents a cost saving of £41 015 per thousand patients tested in primary care. We estimate that outpatient time to diagnosis fell from a median of 41 to 29 days.ConclusionThis audit of FC activity and colonoscopy outcomes provides substantial supportive evidence for the effectiveness of the YFCCP. Popular in primary care, it has led to a reduction in referrals. The diagnostic accuracy determined in this audit is in line with earlier evaluations. Accepting the weaknesses of audit we conclude that this evaluation likely underestimates the benefits of the YFCCP in terms of resource use saving and time to diagnosis.

scholarly journals Evaluation of the clinical and cost-effectiveness of the York Faecal Calprotectin Care Pathway

2018 ◽  
Vol 9 (4) ◽  
pp. 285-294 ◽  
Author(s):  
James Turvill ◽  
Daniel Turnock ◽  
Hayden Holmes ◽  
Alison Jones ◽  
Eleanor Mclaughlan ◽  
...  
Keyword(s):  
Primary Care ◽  
Outcome Measures ◽  
Sensitivity And Specificity ◽  
Care Pathway ◽  
Faecal Calprotectin ◽  
Reactive Protein ◽  
Cost Consequence ◽  
Nice Guidance ◽  
Irritable Bowel ◽  
Primary Care Practices

ObjectiveTo evaluate the sensitivity and specificity of the York Faecal Calprotectin Care Pathway (YFCCP) and undertake a health economics analysis. The YFCCP has been introduced in support of the National Institute for Health and Care Excellence (NICE) guidance DG11. It is designed to improve the sensitivity and specificity of faecal calprotectin (FC) in discriminating the irritable bowel syndrome from inflammatory bowel disease in primary care.DesignTo prospectively evaluate the clinical outcomes at 6 months of the first 1005 patients entering the YFCCP. To develop a cost-consequence model using two comparators: one based on clinical assessment and the C reactive protein/erythrocyte sedimentation rate without using FC, and the second using single testing of the standard FC cut-off.SettingNorth Yorkshire primary care practices.PatientsPrimary care patients fulfilling NICE DG11.InterventionsThe YFCCP.Main outcome measuresClinical outcome measures from secondary care records.ResultsThe sensitivity and specificity of the YFCCP are 0.94 (0.85 to 0.98) and 0.92 (0.90 to 0.94), giving a negative and positive predictive value of 0.99 (0.98 to 1.0) and 0.51 (0.43 to 0.59), respectively.ConclusionsThe YFCCP overcomes the challenges experienced with FC use in primary care, its efficacy matching initial NICE projections. It is readily incorporated into clinical practice. It should represent the framework on which to increase NICE DG11 implementation nationally.

scholarly journals The Association of Introducing a Faecal Calprotectin Testing Pathway for Suspected Inflammatory Bowel Disease in Primary Care and Time to Diagnosis or Treatment

2020 ◽  
Vol 5 (4) ◽  
pp. 191-199
Author(s):  
Amy Hicks ◽  
P. John Hamlin ◽  
Christian P. Selinger
Keyword(s):  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Disease Severity ◽  
Bowel Disease ◽  
Diagnosis And Treatment ◽  
Faecal Calprotectin ◽  
Cancer Pathways ◽  
Time To Diagnosis ◽  
Inflammatory Bowel ◽  
Irritable Bowel

<b><i>Background:</i></b> Primary care faecal calprotectin (FC) was introduced in Leeds in 2014 to distinguish inflammatory bowel disease (IBD) from irritable bowel syndrome and with the hope that it may reduce time to IBD diagnosis and treatment. This study examines the association of FC with referral routes, time to diagnosis, and time to treatment. <b><i>Methods:</i></b> All patients newly referred to IBD clinics in 2013 and 2016 were studied. Data on referral routes and dates, FC, date of first treatment, and proxy outcomes for disease severity were collected. <b><i>Results:</i></b> In 248 patients, there were no differences between 2013 and 2016 cohorts regarding baseline data and disease severity. The number of direct referrals to gastroenterology rose from 3% (2013) to 17% (2016), whilst 10% were diagnosed during emergency admissions. Referrals via suspected cancer pathways remained high (38% in 2013, 28% in 2016), whilst many had initial investigations at independent centres (16% in 2013, 24% in 2016). Time from referral to diagnosis was similar between 2013 (0.77 month) and 2016 (1.10 months, <i>p</i> = 0.2). A total of 48 (33.3%) patients had FC checked prior to referral, and 37.5% of these were referred directly to gastroenterology. Time from diagnosis to treatment reduced from 1.37 months (2013) to 0.72 month (2016, <i>p</i> = 0.01). <b><i>Conclusion:</i></b> Patients present via a multitude of referral pathways, but FC was associated with increased direct referrals to gastroenterology. We found a variation in time to diagnosis and treatment depending on referral routes. Further work is required to ensure patients with suspected IBD get referred to IBD services in a timely manner.

Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
R King ◽  
D Giedrimiene
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Acute Myocardial Infarction ◽  
Primary Care Physician ◽  
Care Physician ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p&lt; 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p&lt; 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p &lt; 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.

scholarly journals Service evaluation for services for younger people with dementia in east locality of north Wales

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S20-S20
Author(s):  
Asha Dhandapani ◽  
Sathyan Soundararajan ◽  
Sharmi Bhattacharyya
Keyword(s):  
Time Frame ◽  
Service Evaluation ◽  
Young Onset ◽  
People With Dementia ◽  
North Wales ◽  
Number Of Patients ◽  
Time To Diagnosis ◽  
Working Age ◽  
The Impact ◽  
Timely Referral

AimsTo evaluate Young-onset dementia (YOD) services in terms of referral, its appropriateness, time to diagnosis and other criteria as per protocol that we have adapted.MethodCase notes of those under 65 referred to Memory service for cognitive assessment between July 2017 and June 2018 were retrospectively reviewed to look at the time to diagnosis, appropriate referrals, post-diagnostic support, etc.ResultCompared to the previous evaluation, the number of patients referred to had increased from 47–48/ year earlier to 63/year. Only 1/3 were appropriate referral over the 10-year period whereas between 2017 and 2018 more than half were appropriate referrals. More than half of them were seen within 12 weeks of referral (35/63 available). Only 132/252 were diagnosed as having some form of dementia in the previous evaluation which was about 13 cases of YOD a year. In contrast, in our new evaluation 19 patients were diagnosed with some form of dementia. Inappropriate referrals had reduced by more than 50%. Appropriateness and timely referral had improved in this time frame.ConclusionDementia is considered ‘young onset’ when it affects people under 65 years of age. It is also referred to as ‘early onset’ or ‘working age’ dementia. However, this is an arbitrary age distinction that is becoming less relevant as increasingly services are realigned to focus on the person and the impact of the condition, not the age. Teaching sessions to educate primary & secondary care clinicians on appropriateness and timely referrals have helped in improving the care for patients with YOD. Services need to be developed further to be able to diagnose & support those with YOD. Repeat evaluations every year would help to inform improvement in quality & appropriateness of referrals.

scholarly journals Mobile Self-Monitoring ECG Devices to Diagnose Arrhythmia that Coincide with Palpitations: A Scoping Review

Healthcare ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 96 ◽  
Author(s):  
Hannah Ramsden Marston ◽  
Robin Hadley ◽  
Duncan Banks ◽  
María Del Carmen Miranda Duro
Keyword(s):  
Primary Care ◽  
Mobile Devices ◽  
Scoping Review ◽  
Care Pathway ◽  
Primary Care Providers ◽  
Positive Trend ◽  
Care Providers ◽  
Heart Monitoring ◽  
The Impact ◽  
Monitoring Devices

The use and deployment of mobile devices across society is phenomenal with an increasing number of individuals using mobile devices to track their everyday health. However, there is a paucity of academic material examining this recent trend. Specifically, little is known about the use and deployment of mobile heart monitoring devices for measuring palpitations and arrhythmia. In this scoping literature review, we identify the contemporary evidence that reports the use of mobile heart monitoring to assess palpitations and arrhythmia across populations. The review was conducted between February and March 2018. Five electronic databases were searched: Association for Computing Machinery (ACM), CINHAL, Google Scholar, PubMed, and Scopus. A total of 981 records were identified and, following the inclusion and exclusion criteria, nine papers formed the final stage of the review. The results identified a total of six primary themes: purpose, environment, population, wearable devices, assessment, and study design. A further 24 secondary themes were identified across the primary themes. These included detection, cost effectiveness, recruitment, type of setting, type of assessment, and commercial or purpose-built mobile device. This scoping review highlights that further work is required to understand the impact of mobile heart monitoring devices on how arrhythmias and palpitations are assessed and measured across all populations and ages of society. A positive trend revealed by this review demonstrates how mobile heart monitoring devices can support primary care providers to deliver high levels of care at a low cost to the service provider. This has several benefits: alleviation of patient anxiety, lowering the risk of morbidity and mortality, while progressively influencing national and international care pathway guidelines. Limitations of this work include the paucity of knowledge and insight from primary care providers and lack of qualitative material. We argue that future studies consider qualitative and mixed methods approaches to complement quantitative methodologies and to ensure all actors’ experiences are recorded.

scholarly journals Does the Primary Care Experience Influence the Cancer Diagnostic Process?

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Sylvie Provost ◽  
Raynald Pineault ◽  
Pierre Tousignant ◽  
Danièle Roberge ◽  
Dominique Tremblay ◽  
...  
Keyword(s):  
Primary Care ◽  
Metastatic Cancer ◽  
Diagnostic Process ◽  
Process Time ◽  
Care Experience ◽  
Usual Source ◽  
Point Of Entry ◽  
Experience Of Care ◽  
Time To Diagnosis ◽  
The Impact

Objective. To analyze the impact of patients’ experience of care at their usual source of primary care on their choice of point of entry into cancer investigation process, time to diagnosis, and presence of metastatic cancer at time of diagnosis. Method. A questionnaire was administered to 438 patients with cancer (breast, lung, and colorectal) between 2011 and 2013 in four oncology clinics of Quebec (Canada). Multiple regression analyses (logistic and Cox models) were conducted. Results. Among patients with symptoms leading to investigation of cancer (n=307), 47% used their usual source of primary care as the point of entry for investigation. Greater comprehensiveness of care was associated with the decision to use this source as point of entry (OR = 1.25; CI 90% = 1.06–1.46), as well as with shorter times between first symptoms and investigation (HR = 1.11; p=0.05), while greater accessibility was associated with shorter times between investigation and diagnosis (HR = 1.13; p<0.01).  Conclusion. Experience of care at the usual source of primary care has a slight influence on the choice of point of entry for cancer investigation and on time to diagnosis. This influence appears to be more related to patients’ perceptions of the accessibility and comprehensiveness of their usual source of primary care.

scholarly journals Evaluation of a faecal calprotectin care pathway for use in primary care

2016 ◽  
Vol 17 (05) ◽  
pp. 428-436 ◽  
Author(s):  
James Turvill ◽  
Shaun O’Connell ◽  
Abigail Brooks ◽  
Karen Bradley-Wood ◽  
James Laing ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Decision Making ◽  
Diagnostic Yield ◽  
Care Pathway ◽  
Gastrointestinal Symptoms ◽  
Clinical Decision ◽  
Traffic Light ◽  
Faecal Calprotectin ◽  
Predictive Values ◽  
Light System

BackgroundNational 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.ObjectivesTo evaluate this care pathway.MethodsThe 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.ResultsThe 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 (&lt;50 mcg/g), without affecting the NPV. In total, 89% of patients with IBD had an FC&gt;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%).ConclusionsA 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.

scholarly journals Preventive treatment for migraine in primary care, a population-based study in the Netherlands

Cephalalgia ◽  
2013 ◽  
Vol 33 (14) ◽  
pp. 1170-1178 ◽  
Author(s):  
F Dekker ◽  
JP Dieleman ◽  
A Knuistingh Neven ◽  
MD Ferrari ◽  
WJJ Assendelft
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Clinical Information ◽  
Preventive Treatment ◽  
Preventive Therapy ◽  
Source Population ◽  
Research Database ◽  
Number Of Patients ◽  
Prior Use ◽  
The Impact

Background Preventive treatment of migraine contributes to reducing the impact of migraine but its extent of use in routine care is unknown. Objective The objective of this article is to assess current use, previous use, duration and course of preventive treatment of migraine in Dutch general practice. Methods We conducted a retrospective cohort study, for the period between 1997 and 2007, in the Interdisciplinary Processing of Clinical Information (IPCI) database, a GP research database in the Netherlands (source population of more than half a million subjects). All prevalent and incident migraine patients ( N = 7367) were included. Results About 13% of all migraine patients currently use preventive therapy and almost half of migraine patients have prior use. Of those starting with preventive treatment, 56% (95% CI: 54.3–64.7) still used it after nine months. There was a long delay between migraine diagnosis and preventive treatment start. Forty-four percent (95% CI 43.0–45.7) started preventive therapy in the study period. Conclusion This large primary-care database study shows that a limited number of patients are current users of preventive treatment, but many patients have prior use. After diagnosis there is often an extended time before preventive treatment is applied. Also there is often only one attempt. The continuation in time seems appropriate. Preventive therapy in migraine still deserves focus.

scholarly journals Impact of the SARS-CoV-2 pandemic on emergency surgery services—a multi-national survey among WSES members

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Martin Reichert ◽  
◽  
Massimo Sartelli ◽  
Markus A. Weigand ◽  
Christoph Doppstadt ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Elective Surgery ◽  
Perforated Appendicitis ◽  
Surgical Patients ◽  
Patient Treatment ◽  
Surgical Patient ◽  
Structural Problems ◽  
Number Of Patients ◽  
Time To Diagnosis ◽  
The Impact

Abstract Background The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It’s impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now. Methods A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients. Results Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients. Conclusions The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services.

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