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

Background: 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. Methods: 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. Results: 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, p = 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, p = 0.01). Conclusion: 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.

背景：2014年利兹地区引入基层医疗用粪便钙卫蛋白（faecal calprotectin, FC），用于鉴别炎症性肠病（inflammatory bowel disease, IBD）与肠易激综合征，以期缩短IBD的诊断与治疗周期。本研究旨在探讨FC与转诊途径、确诊耗时及治疗耗时之间的关联。方法：本研究纳入2013年及2016年首次转诊至IBD专科门诊的所有患者，收集了转诊途径与日期、FC检测结果、首次治疗日期以及疾病严重程度替代结局指标等相关数据。结果：本研究共纳入248例患者，2013年与2016年两个队列的基线数据及疾病严重程度均无显著差异。直接转诊至消化内科的患者占比从2013年的3%升至2016年的17%，另有10%的患者于急诊入院期间确诊。通过疑似癌症转诊通道的患者占比仍较高（2013年为38%，2016年为28%），同时有较多患者先在独立医学中心完成初始检查（2013年为16%，2016年为24%）。2013年与2016年患者从转诊至确诊的耗时无显著差异（分别为0.77个月与1.10个月，p=0.2）。共有48例（33.3%）患者在转诊前接受了FC检测，其中37.5%的患者直接转诊至消化内科。从确诊至治疗的耗时从2013年的1.37个月降至2016年的0.72个月（p=0.01）。结论：疑似IBD患者的转诊途径多样，但FC检测与直接转诊至消化内科的比例升高存在相关性。本研究发现，确诊与治疗的耗时随转诊途径不同而存在差异。未来仍需开展进一步工作，以确保疑似IBD的患者能够及时转诊至IBD专科诊疗服务。