Ultrasound assessment of small bowel Crohn's disease: A mixed methods exploration of barriers and facilitators to implementation in adult NHS IBD services

Radford, Shellie (2023) Ultrasound assessment of small bowel Crohn's disease: A mixed methods exploration of barriers and facilitators to implementation in adult NHS IBD services. PhD thesis, University of Nottingham.

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Background: Crohn’s disease (CD) is a long-term condition which requires repeated disease monitoring via medical imaging, where repeated burdensome medical investigations negatively impact on patients quality of life. Small bowel ultrasound scanning (SBUS) has been shown to be similar in accuracy when compared to magnetic resonance enterography (MRE), has the potential to be quicker, less costly and improve patient experience of care, but it is not routinely used in NHS IBD care.

Objectives: This thesis aims to provide insight on how best to support the implementation of SBUS in practice by collecting information about current national usage and appetite for SBUS uptake, stakeholder perceptions of the adoption of the intervention by health services and the potential impact of use of SBUS on care pathways in routine CD care. Findings from this work will contribute to the production of an implementation package to facilitate national uptake of SBUS in NHS IBD services.

Methods: A scoping literature review and three research studies were undertaken throughout this programme of work. The scoping literature review was undertaken to explore clinical utility of SBUS in IBD settings. A national survey was undertaken to uncover current usage and appetite for use of SBUS in IBD settings. A qualitative semi structured interview study was undertaken to explore stakeholder perceptions of SBUS use and implementation of ultrasound in IBD settings. A care pathway analysis and cost implications analysis were undertaken to gauge the impact of the introduction of SBUS into an NHS IBD service. The quantitative data were analysed using descriptive statistics. Qualitative data were analysed using template analysis.

Results: Ultrasound is reported as quicker, more acceptable to patients and safer when compared to MRE and has been shown to be similarly accurate in detecting presence and extent of small bowel CD. Ultrasound is used widely in central Europe and Canada but has not yet been embraced in the UK. Survey responses indicated that there is an appetite for the uptake of SBUS in NHS services. There is disparity in confidence levels when using ultrasound to make clinical decisions, compared to MRE. The interview study revealed that stakeholders believe that the introduction of SBUS into clinical services would be beneficial to patient experience, outcomes and cost reduction. There are concerns in relation to the availability of training for health care professionals and the belief that there are still concerns relating to accuracy of SBUS compared to MRE. Interview participants believed that the largest barriers to implementation of SBUS in the NHS were the existing practices, beliefs and behaviours of healthcare professionals which are likely to be difficult to amend. Care pathway and costs implications analysis’ showed that there are significant potential cost saving and waiting time reduction implications to the introduction of SBUS into NHS IBD services.

Conclusions: Recommendations from this work which will contribute to the generation of an implementation package for SBUS include the need for well-structured and supported training for health care professionals, tools for identifying and fostering leadership roles in promoting and sustaining change and mechanisms for reviewing and adapting SBUS over time to ensure it meets the needs of stakeholders and IBD services.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Moran, Gordon
Leighton, Paul
Coad, Jane
Keywords: Crohn's disease; Small bowel ultrasound scanning
Subjects: W Medicine and related subjects (NLM Classification) > WI Digestive system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 73923
Depositing User: Radford, Shellie
Date Deposited: 31 Jul 2023 04:41
Last Modified: 31 Jul 2023 04:41
URI: https://eprints.nottingham.ac.uk/id/eprint/73923

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