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The role of faecal calprotectin testing in primary care
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Freeman, Karoline (2020) The role of faecal calprotectin testing in primary care. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3519345
Abstract
Background: Faecal calprotectin (FC) testing has received national approval for the detection of inflammatory bowel disease (IBD) in primary care. Approval was based on evidence taking the secondary care perspective. Transferring evidence between settings may not be appropriate.
Objectives: To produce primary care evidence on the test accuracy, test use and patient management following FC testing. To identify biases and misconceptions in the current evidence base of FC testing. To assess the appropriateness of national recommendations on testing in primary care.
Methods: Retrospective cohort study of primary care electronic health records to investigate the uptake and use of FC testing in routine practice. Triangulation of test accuracy measures using routine primary care data and tailored meta-analysis of studies deemed applicable to primary care. Semi-structured interviews with general practitioners (GPs) to explore influences on referral decisions and the perceived role of FC testing in referral decisions.
Results: Sensitivity of FC testing was high and similar across methods and settings. Specificity was more variable mainly due to differences in the definition of the non-IBD group. Test use was variable and inconsistent. Few patients followed the anticipated patient pathway. FC test negative referrals were close to 50%. Qualitative findings suggested that reasons included clinical uncertainty and patient preferences. Factors other than FC test results were more influential on referral decisions. Secondary care test accuracy estimates and assumptions on test use in the cost-effectiveness model were not applicable to the clinical problem in primary care.
Conclusions: FC testing is a useful test for primary care. It may not be costeffective when used in primary care currently because the intended use does not match the GPs’ reasons for testing and referral. Test evaluations and national guidance for primary care need to consider the primary care context and GPs’ decision-making processes for testing and referral decisions.
Item Type: | Thesis (PhD) | ||||
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Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine |
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Library of Congress Subject Headings (LCSH): | Inflammatory bowel diseases, Inflammatory bowel diseases -- Diagnosis, Inflammatory bowel diseases -- Treatment, Feces | ||||
Official Date: | September 2020 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Clarke, Aileen ; Taylor-Phillips, Sian ; Willis, Brian | ||||
Sponsors: | National Institute for Health Research (Great Britain) | ||||
Format of File: | |||||
Extent: | 342 leaves : illustrations | ||||
Language: | eng |
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