ABSTRACT
Introduction UCLH has developed a modified 'At Home' Capsule endoscopy (ACE) service for patients undergoing capsule endoscopy where the entire procedure is completed at home through remote (telemedicine) assistance. This aimed to improve access to endoscopy services during the covid-19 pandemic. This a preliminary review of the ACE focusing on procedure safety, success rates and patient satisfaction. Methods Data on all ACE procedures at UCLH was looked at prospectively. Demographics, completion rates, and complication rates were recorded. All patients were asked to complete patient satisfaction questionnaires relating to the at home process (experience of the process, support from staff, expectations, tolerance of procedure, satisfaction, and preference for future investigations). Results 34 ACE procedures were looked at for this study. 13 were colon capsule endoscopies (CCE) and 21 small bowel capsule endoscopies (SBCE). Mean age of participants was 38 years and 17 (50%) were males. Indications were FIT positive (2.9%), iron-deficiency anaemia (14.7%), inflammatory bowel disease (61.7%) or investigation of other symptoms (20.6%). 31 (91.1%) procedures were successful- defined as a complete procedure with adequate bowel preparation. There were 3 failed ACEs (2= poor prep, 1= capsule not excreted). There were no complications and no need to convert the remote test to 'in-hospital'. 16 (47%) patient satisfaction questionnaires were returned. No patients found the procedure painful or embarrassing and 12 (75%) patients were not anxious prior to their procedure. On a satisfaction scale of 1-10, 12 patients (75%) scored ACE as ≥8. 13 (81.3%) patients would choose to have ACE vs inhospital CE. 12 (75%) patients would choose ACE as their preferred colonic investigation over CE in-hospital, colonoscopy, and CT colonography. Importantly, 87.5% of those patients had previously undergone a colonoscopy. Conclusions This is preliminary data on ACE, which shows a similar safety and success rate to standard practice in-hospital capsule endoscopy. 75% of patients preferred ACE over any other colonic investigation, suggesting potential increased acceptance by the public as a colorectal cancer screening test.
ABSTRACT
Introduction The COVID-19 pandemic presented many challenges but also opportunities to introduce new models of delivering care. There has been widespread increased usage of virtual appointments. However few studies have measured patient's experiences and opinions of different models of care. Method We retrospectively invited all IBD patients seen in 2 consecutive clinic days in November 2021 at a large tertiary hospital to participate. All patients were contacted via telephone and a structured feedback questionnaire was used to collect data. Demographic and appointment data was collected from EPIC electronic healthcare records. Results 175 patients were invited to participate. 100 patients (57%) were contactable and willing to complete the telephone questionnaire. The median age was 44 years (range 21-80). Most clinic appointments at this time were virtual. of the 100 patients who responded 10 had F2F and 90 had virtual appointments. 4/10 (40%) patients attending F2F appointments needed to take time off work compared to 14/90 (16%) of patients who had virtual appointments. 100% of patients who had F2F appointments and 99% of patients who had virtual appointments reported a good understanding of what was discussed during their consultation. Similarly, 100% of F2F patients and 96% of virtual patients, felt able to ask questions and that their opinions were considered during their consultations. When offered a simple binary choice 49% patients preferred face to face appointments, 36% preferred virtual and 15% had no preference. However, when asked about other models of care 45% preferred alternating virtual and F2F appointments, 34% chose F2F only when having a flare, only 15% wanted all appointments F2F while 4% wanted all virtual appointments (Figure 1). Conclusion IBD patient satisfaction, understanding, and opportunity to ask questions was high and similar in both F2F and virtual. Virtual reduce the need to take time off work. In our cohort of IBD patients 79% of patients would prefer a hybrid model of care going forward.