A qualitative analysis of colon capsule endoscopy using a novel GP-led, home-delivered service model in the Western Isles, Scotland

Early Abstract:

Introduction: A novel GP-led, home-delivered colon capsule endoscopy service (CCE) was developed and delivered in the remote Western Isles, Scotland. This service model may address issues faced by rural dwellers in accessing traditional colonoscopies. Staff perspectives on the development, delivery and impact of this service model may assist decision-makers and future researchers in understanding the nuances of colon capsule endoscopy delivery models in rural areas.
Methods: An interview schedule was developed and participants were recruited from an estimated population of 27 staff members involved in the CCE service. Purposive sampling was used to ensure participants were from diverse job families and work locations, capturing the service from different perspectives. Participants undertook semi-structured interviews on Microsoft Teams between July and September 2024. We used an iterative grounded-theory approach to theme generation using broad interview topics as a guide to ensure the analysis met the research aims. Data were analysed using thematic analysis 5-stage approach. 
Results: Eleven participants from Scotland’s National Health Service (NHS) boards, including NHS Western Isles, NHS Highland and NHS National Services Scotland, underwent interview. Job families represented included medical, nursing, and administrative. Participants identified unique enablers and barriers to the development and delivery of the service. The island’s remote geography, for example, was an enabler in the development of the unique service model but occasionally a barrier during service delivery. Advantages and disadvantages were broadly grouped into those for patients,  staff, and  the healthcare system. Advantages included reduced patient travel and improved job satisfaction. Participants did not identify significant risks with this service model. There was some uncertainty and disagreement regarding certain service impacts, including economic benefit and impacts on the endoscopy service.
Discussion: Other services may find participant reflections on the enablers, barriers and risk management strategies of this service useful when considering similar changes. Participant reflections on their own experiences, including advantages and disadvantages for staff, can be taken at face-value whereas reflections on the patient experience require further evaluation with patients themselves. There was uncertainty and disagreement about some of the impacts of the service and its economic benefit, where limited conclusions may be drawn without further research.
Conclusion: Our research identified key enablers and barriers to the development and delivery of GP-led, hospital-at-home delivered colon-capsule endoscopy in a remote part of Scotland. While participants expressed broad agreement about advantages and disadvantages of the service, including significant benefits for staff, some of these require further evaluation from the patient perspective. Similarly, there were areas where participants were uncertain or disagreed about the impact of the service requiring further quantitative and economic evaluation.
Keywords: remote, rural, colorectal cancer, colon capsule endoscopy, primary care, hospital at home, diagnostics, qualitative