Introduction NICE recommend faecal calprotectin (FC) testing to help differentiate between irritable bowel syndrome and other pathologies including inflammatory bowel disease (IBD) in adults for whom specialist assessment is being considered. We aimed to explore the impact of introducing GP FC testing on referrals to secondary care.
Method GPs within Southampton City and West Hampshire CCGs were invited to request FC in adults under 45 with symptoms that could initiate referral. Before requesting electronically, GPs answered questions on patient history and if they planned to refer the patient. GP/hospital data was collected electronically from April 2015-June 2016 and reviewed according to FC (<50: negative, 50–99: indeterminate, ≥100: positive) as a service evaluation.
Results 59/64 (92%) of GP surgeries used FC testing. 410/435 samples received were processed: 66 (16%) positive, 33 (8%) indeterminate, 311 (76%) negative. 85/410 (21%) patients were referred to secondary care (60% positive/indeterminate FC). Mean monthly gastroenterology (including non-IBD) referral rates were unchanged from 2014/15 to 2015/16 (187 vs. 186/mth). 16/410 were diagnosed with IBD (19% of FC referrals, all positive/indeterminate FC). Of 66 patients with positive FC, only 43 (65%) were referred, with no referral/appointment on record for the remaining 23.
When asked ‘would you refer even if FC was negative?’ in 55/410 cases GPs responded ‘yes’, but only referred 22 (40%). Of 176/410 cases where the response was ‘no’, 13 (7%) were referred. When asked ‘would you refer if FC was not available?’ in 205/410 cases GPs responded ‘yes’ but only referred 52 (25%). Of 34/410 cases where the response was ‘no’, 4 (12%) were referred. GPs were twice as likely to report planning to refer patients who ultimately had a positive FC than those with a negative FC (24% vs. 11%), suggesting these patients may have symptoms of greater concern.
56/85 (66%) of referred patients (14 with negative FC) underwent lower GI endoscopy (30/56 (53%) normal, 16/56 (29%) IBD, 4/56 (7%) microscopic colitis, 1/56 (2%) cancer, 5/56 (9%) other). Mean times from referral to outpatient clinic and endoscopy: 69 and 93 days. Despite being at higher risk of IBD, the mean time from referral to clinic for patients with positive FC was only slightly less than for negative FC (64 vs. 78 days).
Conclusion FC testing was requested by most GP practices but in low numbers and a significant number of patients with positive FC were not referred. FC did appear to influence GP decision-making regarding referral. Local pathways will be developed to introduce a Positive FC clinic to streamline referrals and aim to improve time to IBD diagnosis.
Disclosure of Interest None Declared
- FAECAL CALPROTECTIN
- Inflammatory Bowel Disease
- Primary care