N25 Outcomes of a GP outreach programme to offer colonoscopic surveillance for IBD patients being managed in primary care
H. Windak, V. Cairnes, N. Chanchlani, C. Desmond, B. Hamilton, N. Heerasing, P. Hendy, L. Simeng, N.A. Kennedy, J. Goodhand, T. Ahmad, C. Gordon
Gastroenterology, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
Background
Colonoscopic surveillance in IBD patients can reduce the development of colorectal cancer (CRC) and the rate of CRC-associated death. We recently reported that 27% of IBD patients living in East Devon are managed exclusively in primary care of whom about 23% maybe eligible for colonoscopic surveillance. We devised an outreach programme, whereby we invited primary care physicians to enrol these patients in a colonoscopic surveillance programme.
Methods
In December 2017, we contacted 37 general practices, where 161 patients with UC who were eligible for surveillance had been identified. Each practice was sent a letter explaining the goals of the project, a link to the National Institute for Healthcare and Clinical Excellence (NICE) guidance for CRC surveillance in IBD patients and patient information booklets. We informed the practices of their eligible patients and asked them to refer patients for secondary care IBD consults if appropriate. We included an outcome form that captured whether the patient was referred, was deemed inappropriate for surveillance, had surveillance elsewhere, had declined surveillance, or was no longer registered at the practice.
Results
Sixty-five percent of practices (24/37) responded and we received responses for 57 of 161 (35%) potentially eligible patients. Thirty-five (61%) patients were referred to our IBD service; 7 (12%) patients declined surveillance; 7 (12%) patients were deemed by their GP to be unfit for surveillance and 5 (10%) were no longer registered at the identified GP practice; 2 (4%) had surveillance arranged elsewhere and 1 (2%) patient had died. Amongst the 35 patients referred to secondary care; 22 (63%) underwent surveillance colonoscopy, 12 (34%) declined surveillance after discussion or did not attend their booked appointments and one is awaiting colonoscopy. Half of patients who had a colonoscopy had active inflammation. We diagnosed one CRC He was an elderly man with a locally invasive signet ring caecal tumour, without distant metastases, who went onto to have a curative right hemicolectomy without complication.
Conclusion
Patients with longstanding IBD are frequently managed exclusively in primary care and maybe overlooked for colonoscopic CRC surveillance. There is a need to implement processes to facilitate identification and recall of patients eligible for surveillance across primary and secondary care.