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Factors Associated With Fecal Calprotectin Sample Collection Compliance: An IBD Center Quality Improvement Project
David Fenton1, Natalie K Choi2, Nicole M Garcia2
1Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
Insights
Patient compliance with fecal calprotectin (Fcal) testing for inflammatory bowel disease (IBD) is low. Prior test completion and testing site location impact compliance, with home testing offering potential improvements.
Area of Science:
- Gastroenterology
- Clinical Biomarkers
- Inflammatory Bowel Disease
Background:
- Fecal calprotectin (Fcal) is a valuable noninvasive biomarker for assessing inflammatory bowel disease (IBD) activity.
- Patient adherence to Fcal testing is variable and not well understood.
- Understanding compliance factors is crucial for effective IBD management.
Purpose of the Study:
- To assess compliance rates with Fcal testing in IBD patients.
- To identify demographic, clinical, and test-related factors associated with Fcal test noncompliance.
- To provide insights for improving Fcal test utilization.
Main Methods:
- Retrospective chart review of IBD patients with ordered Fcal tests (August-December 2021).
- Collection of demographic, clinical, disease, and test-specific data.
- Survey of noncompliant patients to determine reasons for noncompletion.
- Statistical analysis including multivariable logistic regression.
Main Results:
- 54.4% of patients had an Fcal test ordered; 33.3% of ordered tests were not completed.
- IBD remission, no prior Fcal completion, and distant testing sites were linked to noncompliance.
- Prior Fcal completion significantly increased subsequent test completion (OR=2.1, P=.004).
- Pandemic and third-party testing issues were cited as primary reasons for noncompliance.
Conclusions:
- History of incomplete testing and distant lab locations are significant barriers to Fcal test completion in IBD patients.
- Strategies to improve compliance may include home-based testing options.
- Addressing patient-reported barriers is essential for optimizing Fcal test utility in IBD care.
Background:
Fecal calprotectin (Fcal) is a noninvasive, inexpensive biomarker of disease activity. However, patient compliance with this test is variable and incompletely described. We assessed compliance rates with Fcal tests and identified factors associated with noncompliance.
Methods:
A retrospective chart review of patients with inflammatory bowel disease (IBD) who had a Fcal test ordered through our center between August 2021 and December 2021 was conducted. Demographic, clinical, disease, and test-related information were recorded. Patients with incomplete Fcal orders were sent a survey to better understand their reasons for noncompliance. Simple statistical analysis and and multivariable logistic regression modeling were performed.
Results:
Of 303 patients, 165 (54.4%) had an order for Fcal. Of the Fcal tests ordered, 55 (33.3%) were not completed. Remission of IBD, no prior Fcal completion, and tests ordered at a distant site were all associated with test noncompletion. A multivariable logistic regression revealed that history of a prior completed Fcal test is associated with subsequent test completion (odds ratio = 2.1, 95% confidence interval 1.9-35.5, P = .004). Patients who did not complete the test described the pandemic and third-party testing center issues as the most common reasons for noncompliance.
Conclusions:
In this single center experience with Fcal testing in patients with IBD, we identified that a history of incomplete Fcal testing and distant location of lab testing were significantly associated with noncompletion of the test. We provide practical guidance for future utilization and compliance, including the impact of home-based testing.
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