P281 TELEIBD: A telematic fast-track pathway for patients with high suspicion of Inflammatory Bowel Disease in primary care

Abstract

Background The incidence and prevalence of Inflammatory bowel disease (IBD) are increasing in the last years. In primary care (PC) patients often present with confusing and non-specific symptoms which can often be a delay in referring and diagnosing suspected IBD. The average time from symptom onset to diagnosis of IBD is longer than five years in up to 18% of cases and 64% of patients presenting to emergency care with symptoms of IBD prior to the diagnosis. Shared care protocols and closer working with integrated care teams can bridge the gap between primary and specialized care, improving their assistance Methods This is a retrospective study that evaluates the results of TELEIBD (telematic circuit care) in patients with high diagnostic suspicion of IBD between PC and IBD Unit of our health area since its implementation in August 2019 to October 2020. The number of telematic consultations, average resolution time, adaptation to referral criteria, complementary tests requested and diagnostic confirmation were evaluated. TELEIBD establishes the issuance of a telematic consultation through the electronic clinical history when a patient meets previously established criteria. Specialized IBD physician who evaluates the case, can advise a diagnostic or therapeutic attitude either by electronic means or face-to-face with the patient. Results A total number of 77 care consultations from 77 patients (58,4% females) have been made. The average age was 49,2 years and the average reponse time were 7,5 days. After teleconsultation, 46 patients (59.7%) were not requested medical test. Lower gastrointestinal endoscopy (LGE) was performed in 25 patients, blood and faecal calprotectin testing in 7 patients, magnetic resonance (MR) or computer tomographic (CT) enterography in 6 patients. Taking into account the criteria for referral to a specialist, a total of 15 patients (19,5%) fully met the criteria, 13 patients (16,9%) partially met the criteria and 49 patients (63,6%) did not meet it. The main reason fot not meeting the criteria were the inadequated use of TELEIBD (53,1%). Of the 25 LGE requested, 3 were suggestive of Ulcerative Colitis (UC) and 1 of Crohn’s Disease (CD). Diagnosis of CD was confirmed in 2 patients, using MR or CT enterography. Diagnoses were reached in 4 patients, 3 of the group that met referral criteria (20%) and 1 of the group that partially met it (7.7%). The diagnosis was not achieved in any patient who did not partially and/or fully meet the referral criteria. Conclusion TELEIBD can be a useful tool for the quick assessment of patients who meet the criteria for high suspicion of IBD. Training primary care physicians in the referral criteria of the pathway is essential to improve the functioning of the circuit.