BackgroundFaecal calprotectin (FCal) levels are used as a surrogate marker for mucosal inflammation, but thresholds for defining endoscopic or histological disease activity in ulcerative colitis UC) remain unclear. MethodsUsing validated indices, prospective measurements of FCal, symptoms (Simple Colitis Clinical Activity Index, SCCAI), endoscopic (Ulcerative Colitis Endoscopic Index of Severity, UCEIS) and histological activity (Nancy index) were made over 6 months in patients enrolled into the TrueColours UC web-based monitoring programme. Repeated measurements correlation was performed between FCal and SCCAI, UCEIS and Nancy indices using definitions for remission and active disease (UCEIS: remission1, active4; Nancy: remission1, active2; Combined criteria: remission UCEIS1 and Nancy1, active UCEIS4 and Nancy2). Receiver operating characteristic curves investigated FCal thresholds after maximising sensitivity for active disease. ResultsIn 39 patients followed prospectively for 6 months, correlation coefficients between FCal and SCCAI, UCEIS and Nancy indices were 0.271 (95% CI 0.114-0.415), 0.741 (95% CI 0.289-0.922) and 0.876 (95% CI 0.605-0.965) respectively. Median FCal thresholds for remission using endoscopic, histologic, or combined criteria were 71g/g (range 8-624), 91g/g (range 8-858) and 67g/g (range 8-479), respectively. The FCal threshold above which active disease was confirmed was 187g/g for UCEIS (AUC 0.915), 72g/g for Nancy (AUC 0.824) and 187g/g for combined endoscopic and histologic criteria (AUC 0.936). ConclusionsCorrelation between FCal and symptoms in UC is weak. In contrast, the correlation between FCal and endoscopic or histological activity is strong. An FCal 72g/g indicates histological inflammation (Nancy 2) and 187g/g indicates endoscopically active disease (UCEIS 4), whether combined with histopathology or not. *Values presented as median (range), UCEIS: remission 1, active 4; Nancy: remission 1, active 2; Combined criteria: remission UCEIS 1 and Nancy 1, active UCEIS 4 and Nancy 2.Values are presented as median (95% CI). FCal = IBDoc faecal calprotectin (measured in g/g of faeces) PPV = positive predictive value, NPV = negative predictive value, LR+ = positive diagnostic likelihood ratio, LR-= negative diagnostic likelihood ratio, AUC = area under curve
Background/Aims TrueColours ulcerative colitis (TCUC) is a comprehensive web-based program that functions through email, providing direct links to questionnaires. Several similar programs are available, however patient perspectives are unexplored. Methods A pilot study was conducted to determine feasibility, usability and patient perceptions of real-time data collection (daily symptoms, fortnightly quality of life, 3 monthly outcomes). TCUC was adapted from a web-based program for patients with relapsing-remitting bipolar disorder, using validated UC indices. A semi-structured interview was developed and audio-recorded face-to-face interviews were conducted after 6 months of interaction with TCUC. Transcripts were coded in NVivo11, a qualitative data analysis software package. An inductive approach and thematic analysis was conducted. Results TCUC was piloted in 66 patients for 6 months. Qualitative analysis currently defies statistical appraisal beyond “data saturation,” even if it has more influence on clinical practice than quantitative data. A total of 28 face-to-face interviews were conducted. Six core themes emerged: awareness, control, decision-making, reassurance, communication and burden of treatment. There was a transcending overarching theme of patient empowerment, which cut across all aspects of the TCUC experience. Conclusions Patient perception of the impact of real-time data collection was extremely positive. Patients felt empowered as a product of the self-monitoring format of TCUC, which may be a way of improving self-management of UC whilst also decreasing the burden on the individual and healthcare services.
Background Telephone-based digital triage is widely used by services that provide urgent care. This involves a call handler or clinician using a digital triage tool to generate algorithm-based care advice, based on a patient’s symptoms. Advice typically takes the form of signposting within defined levels of urgency to specific services or self-care advice. Despite wide adoption, there is limited evaluation of its impact on service user experience, service use and clinical outcomes; no previous systematic reviews have focussed on services that utilise digital triage, and its impact on these outcome areas within urgent care. This review aims to address this need, particularly now that telephone-based digital triage is well established in healthcare delivery. Methods Studies assessing the impact of telephone-based digital triage on service user experience, health care service use and clinical outcomes will be identified through searches conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. Search terms using words relating to digital triage and urgent care settings (excluding in-hours general practice) will be used. The review will include all original study types including qualitative, quantitative and mixed methods studies; studies published in the last 20 years and studies published in English. Quality assessment of studies will be conducted using the Mixed Methods Appraisal Tool (MMAT); a narrative synthesis approach will be used to analyse and summarise findings. Discussion This is the first systematic review to evaluate service user experience, service use and clinical outcomes related to the use of telephone-based digital triage in urgent care settings. It will evaluate evidence from studies of wide-ranging designs. The narrative synthesis approach will enable the integration of findings to provide new insights on service delivery. Models of urgent care continue to evolve rapidly, with the emergence of self-triage tools and national help lines. Findings from this review will be presented in a practical format that can feed into the design of digital triage tools, future service design and healthcare policy. Systematic review registration This systematic review is registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO 2020 CRD42020178500).
ObjectiveTo evaluate service use, clinical outcomes and user experience related to telephone-based digital triage in urgent care.DesignSystematic review and narrative synthesis.Data sourcesMedline, Embase, CINAHL, Web of Science and Scopus were searched for literature published between 1 March 2000 and 1 April 2020.Eligibility criteria for selecting studiesStudies of any design investigating patterns of triage advice, wider service use, clinical outcomes and user experience relating to telephone based digital triage in urgent care.Data extraction and synthesisTwo reviewers extracted data and conducted quality assessments using the mixed methods appraisal tool. Narrative synthesis was used to analyse findings.ResultsThirty-one studies were included, with the majority being UK based; most investigated nurse-led digital triage (n=26). Eight evaluated the impact on wider healthcare service use following digital triage implementation, typically reporting reduction or no change in service use. Six investigated patient level service use, showing mixed findings relating to patients’ adherence with triage advice. Evaluation of clinical outcomes was limited. Four studies reported on hospitalisation rates of digitally triaged patients and highlighted potential triage errors where patients appeared to have not been given sufficiently high urgency advice. Overall, service users reported high levels of satisfaction, in studies of both clinician and non-clinician led digital triage, but with some dissatisfaction over the relevance and number of triage questions.ConclusionsFurther research is needed into patient level service use, including patients’ adherence with triage advice and how this influences subsequent use of services. Further evaluation of clinical outcomes using larger datasets and comparison of different digital triage systems is needed to explore consistency and safety. The safety and effectiveness of non-clinician led digital triage also needs evaluation. Such evidence should contribute to improvement of digital triage tools and service delivery.PROSPERO registration numberCRD42020178500.
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