Barriers and enablers to implementation of Point of Care Ultrasound (POCUS) service for patients with Crohn’s Disease in the NHS.
What we are doing?
Crohn’s Disease (CD) is one of the two main forms of Inflammatory Bowel Disease (IBD). CD most commonly affects the small bowel (SBCD) but has the potential to affect multiple areas of the GI Tract.
We hypothesise that a small bowel ultrasound based IBD service is a more cost-effective at assessing, diagnosing and managing SBCD, when compared to MRE.
We aim to investigate:
- Confidence in decision making of consultant gastroenterologists using SBUS.
- Pilot cost effective data comparing SBUS and MRE
- Key issues with service implementation identified by stake holders, in order to identify bottle necks in service expansion
Why we are doing it?
The use of SBUS in IBD clinical care is not currently UK practice, nor is it routinely incorporated into clinical research trials. It is only available in a few specialist practices; however it is widely used in Central Europe and Canada. 2019/20 NHS tariff reports the cost for a MRI procedure with pre and post contrast is £157, with an additional reporting cost of £22. In comparison the cost of an ultrasound scan is £49, inclusive of reporting.
What the benefits will be and to whom?
Drugs should be targeted at patients most likely to benefit, and after initiation they should only be continued in patients for those patients where sustained therapeutic efficacy. This would reduce the number of patients receiving costly, and potentially toxic treatments, for no clinical benefit. It would be a significant clinical, and financial, advantage to identify at an early stage which patients will and will not respond to treatment, and switch patients to alternative therapies as appropriate. The length of diagnostic delay due to long waiting times for MRI is correlated with an increased risk of bowel stenosis and CD-related intestinal surgery as well as increased patient anxiety regarding health status. It has also been shown that diagnostic delay in IBD leads to increased costs to patients and health care institutions, negatively impacting on patients quality of life.
Who we are working with?
We will collaborate with regional and national stakeholders, SME and patients to establish an expert panel to contribute to the development, implementation and evaluation of the service.
Shellie Jean Radford, IBD Nurse Researcher and PhD student, Nottingham Biomedical Research Centre – Gastrointestinal and Liver disorders, firstname.lastname@example.org