Mail-Order Stool Testing Improves Patient Experience in Patients With Inflammatory Bowel Disease

Background:
In patients with inflammatory bowel disease (IBD), the use of stool testing is an important part of disease monitoring and evaluation of active symptoms, as both infection and inflammation can share similar symptoms. Prior studies have shown lower acceptability and compliance among patients for stool collection as a clinical disease monitoring tool. Often, patients do not complete or postpone completing stool testing subsequently leading to a delay in reporting of results, especially when the testing is completed at a different facility. These challenges prompted development of a new stool testing workflow through mail-order stool kits. The aim of this study was to evaluate patients’ experience of completing stool testing using mail-order stool kits.
Methods:
Using EPIC’s reporting tool, patients with IBD at a single tertiary care center who have been sent mail-order stool kit(s) within the past 6 months were identified. Patients were then sent a link for an anonymous survey through the online patient messaging portal using REDCap. The survey included demographic information, including gender, age, IBD diagnosis, diagnosis date, distance from IBD center and from external facilities (i.e. Quest or LabCorp), previous experience with non-mail order stool testing, experience with mail-order stool kit, and a general comments section.
Results:
Mail-order stool kits were ordered for 1348 patients. A total of 284 patients with IBD completed the survey (21%). Mail-order stool testing was completed by 133 of the survey respondents (47%); 42 respondents with complete survey data were included in the mail-order stool testing experience analysis. The mean age was 58.9±15.3 years, 83.3% female, with a reported IBD diagnosis mean duration of 15.9±14.6 years. Over half (n=24; 57.1%) had Crohn’s disease, 11 (26.2%) ulcerative colitis, 5 (11.9%) with microscopic colitis, 1 (2.4%) with pouchitis, and 1 (2.4%) who is unsure of their IBD diagnosis. The majority of respondents (90.5%) would recommend use of a mail-order stool kit for future stool sample collection, 88% felt that mail-order stool kit was easy to use and more convenient than completion of non-mail order stool testing, 78.5% felt that results were able to be addressed in a timelier manner, and 81% felt that mail-order testing removed barriers for stool testing completion. Most (n=201, 82.7%) of the 243 patients with IBD who completed traditional stool testing noted that they would be interested in completing mail-order stool testing in the future.
Conclusions:
This is the first reported study to examine patient experience with mail-order stool testing. Patients indicated an overall positive experience with this process and would choose to use mail-order stool testing over non-mail order (traditional) stool testing moving forward. This suggests that the use of mail-order stool kits, especially for patients with IBD, who often need frequent stool testing, may improve testing completion, leading to appropriate and timely evaluation and treatment. Further studies will look at overall improved compliance associated with use of mail-order stool testing, timeliness of results, and overall impact on IBD outcomes.