scholarly journals A173 INNOVATIVE CARE FOR INFLAMMATORY BOWEL DISEASE PATIENTS DURING THE COVID-19 PANDEMIC: USE OF BEDSIDE INTESTINAL ULTRASOUND TO OPTIMIZE MANAGEMENT

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 184-185
Author(s):  
K L Novak ◽  
C Ma ◽  
H Kheirkhahrahimabadi ◽  
j heatherington ◽  
R Ingram ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Acute Care ◽  
Bowel Disease ◽  
Care Pathway ◽  
Clinical Care ◽  
Tertiary Care ◽  
Care Utilization ◽  
Non Invasive ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background The COVID-19 pandemic has led to significant alterations in the ability to deliver outpatient care to patients with inflammatory bowel disease (IBD) including endoscopic evaluation. This has highlighted the need for alternative, accurate, non-invasive strategies to safely assess disease activity. Aims The aim of this study is to describe the impact of point of care intestinal ultrasound (IUS) in a university-based tertiary care IBD urgent access clinic. Methods We prospectively evaluated a comprehensive care pathway which incorporated outpatient sigmoidoscopy and intestinal ultrasound with the purpose of directing further ambulatory clinical care and avoiding hospitalization or hospital-based investigations including endoscopy during the COVID pandemic for patients with established IBD with symptoms suggestive of a disease flare, or those at high risk of a new diagnosis of IBD. Non-invasive markers C Reactive Protein (CRP) and fecal calprotectin (fCal) were collected where available. Patients were pre-screened for influenza-like illness, as COVID-19 testing was not available for this population during the study period. Substantial management changes were defined as addition of any medications, biologic switch/ optimization, and or referral for surgical consultation. Results Between March 15th and June 30th 2020, a total of 72 patients were seen in the urgent access clinic. All patients were seen within 7 days of referral. The majority were female 57% (41/72) and/ or had Crohn’s disease 65.5% (47/72) (Table 1). Of these, 84.7% (61/72) underwent a substantial management change based on features of active inflammation detected by either IUS alone (53% 38/72) sigmoidoscopy alone (12.5% 9/72) or combination IUS with in-clinic sigmoidoscopy (32% 23/72) in addition to CRP and fCal. Three new diagnoses of IBD were made: one colonic Crohn’s and 2 with ulcerative colitis. One pregnant patient avoided all acute care utilization. Five patients were referred to colorectal surgery for urgent resection including two patients admitted directly for emergent operations. No patients required visits to the emergency department. Furthermore, there have been no unscheduled hospitalizations occurred in this cohort since inception March 23, 2020 til November 15th 2020. Conclusions The implementation of IUS in a centralized, urgent access clinic pathway resulted in efficient and meaningful changes in IBD management while sparing the need for acute care services including ER visits, need for in-hospital endoscopy, and hospitalization. The pandemic highlights the utility of this patient-center tool and supports expansion of wider IUS adoption. Funding Agencies None

scholarly journals A103 PIVOTING IN A PANDEMIC: THE IMPACT OF COVID-19 ON THE PROVISION OF CARE FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A PRELIMINARY ANALYSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 79-80
Author(s):  
G Malhi ◽  
M Mikail ◽  
G Minhas ◽  
J Chambers ◽  
R Khanna ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Length Of Stay ◽  
Bowel Disease ◽  
Tertiary Care ◽  
Infectious Complications ◽  
Care Utilization ◽  
Tertiary Care Centre ◽  
Inflammatory Bowel ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, also known as COVID-19, was declared a worldwide pandemic in March of 2020. Since the onset of the pandemic, the focus of many healthcare systems has shifted toward limiting non-essential visits to hospitals in order to prioritize and allocate resources toward treating those affected by COVID-19, and preventing further exposures. While the effect of COVID-19 has been felt amongst many patient populations, those with inflammatory bowel disease (IBD) have been particularly impacted through delayed appointments and endoscopy, which is critical in disease monitoring. Aims We aimed to determine how changes to the provision of IBD care due to the COVID-19 pandemic have affected IBD patients. Methods A retrospective cohort study was conducted using administrative data comparing IBD patients admitted to the gastroenterology ward from March 17 to August 31 2019, with IBD patients admitted from March 17 to August 31 2020 at a tertiary care centre in London, Ontario. Patients were reviewed to assess differences in care utilization and IBD-related outcomes such as hospitalization, surgery and length of stay and in-patient drug therapy. Results A total of 538 patients (259 in 2019 cohort and 279 in 2020 cohort) were reviewed with 48 and 60 IBD patients meeting the inclusion criteria for 2019 and 2020 respectively. Patient demographics were similar between 2019 and 2020 cohort for age, sex, rurality, disease type, and biologic exposure. A greater proportion of patients were admitted with IBD flares in 2020 (86.7% vs 75%, p=0.03). Furthermore, the 2020 cohort also had a 45% increase in in-patient surgical consultations (p=0.07), a 50% increase in in-patient IBD-related surgeries (p=0.39), a 69% increase in inpatient Remicade prescription (p=0.13) and a 70% increase in infectious complications at presentation to hospital (p=0.21). A shorter median length of stay was reported for patients in the 2020 cohort (4 days IQR 3.95 vs 5.85 IQR 4.65, p=0.09). Conclusions Preliminary data suggest that during the COVID-19 pandemic, we have seen more deleterious outcomes in our IBD patients such as increased flares necessitating hospital admission. There was also a non-significant trend toward increased infectious complications as well as in-patient surgeries and need for in-patient Remicade. Though these results cannot be fully interpreted due to the need for further sampling, they suggest that IBD patients may be at-risk for poor outcomes in the current climate of medical care. Completion of this study will help define the full impact of care shifts related to reducing the spread of the novel coronavirus on IBD patients and highlight areas of care that need careful assessment and consideration to protect IBD patient health. Funding Agencies None

scholarly journals P620 Pivoting in a pandemic: The impact of COVID-19 on the provision of care for patients with Inflammatory Bowel Disease – A retrospective study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S560-S561
Author(s):  
G Malhi ◽  
J Chambers ◽  
G Minhas ◽  
M Mikail ◽  
R Khanna ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Length Of Stay ◽  
Bowel Disease ◽  
Tertiary Care ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Patient Demographics ◽  
Inflammatory Bowel ◽  
Provision Of Care ◽  
The Impact

Abstract Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, also known as COVID-19, initially began in a small cluster of patients in Wuhan, China and was declared a worldwide pandemic in March of 2020. Since the onset of the pandemic, the focus of many healthcare systems has shifted toward limiting non-essential visits to the hospital in order to prioritize and allocate resources toward treating those affected by COVID-19. While the effect of COVID-19 has been felt amongst many patient populations, those with Inflammatory Bowel Disease (IBD) have been particularly impacted. We aimed to determine how changes to the provision of IBD care due to the COVID-19 pandemic has affected IBD patients. Methods A retrospective cohort study was carried out in patients with an IBD diagnosis comparing patients admitted to two tertiary care centres affiliated with Western University in London, Canada between March 17 and August 31 2019 (2019 cohort or pre-pandemic), to patients admitted between March 17 and August 31 2020 (2020 cohort or pandemic). Patients were reviewed to assess any differences in care utilization and IBD-related outcomes such as hospitalization, need for surgery, length of stay in hospital and in-patient drug therapy during the defined time periods. Results A total of 863 patients were reviewed in 2019, and 554 in 2020. Of those, 184 (CD, n= 125; UC, n= 59) and 172 (CD, n= 109; UC, n= 62) encounters met the inclusion criteria for 2019 and 2020 respectively. Patient demographics were similar between 2019 and 2020 cohort with the exception of age (2019, mean age = 44.76 years ± 16.78; 2020, mean age=50.36 years ± 17.82, p=0.002). The length of stay in hospital was shorter in 2020 (6.88 days vs 9.63, p=0.045). Significantly fewer patients were initiated on Infliximab in hospital in 2020 (2020, 3.50 per month; 2019, 6.83 per month, p=0.001). Fewer in-patient surgeries were performed in 2020 (2019, 76; 2020, 57; p=0.112). Conclusion Preliminary data demonstrate during the COVID-19 pandemic there was a significant reduction in the length of stay for patients with IBD as well as fewer patients initiated on infliximab while in hospital. There was also a decrease in the number of surgeries performed in 2020. These differences may reflect an effort to minimize contact between patients and health care facilities as well as reduce the introduction of further immunosuppression. Further research will be to determine whether if more ER visits became hospitalizations and any delays in appointment times or endoscopies, or compliance issues with medications may have led to these aforementioned outcomes.

Patient Experiences and Outcomes of a Telehealth Clinical Care Pathway for Postoperative Inflammatory Bowel Disease Patients

2020 ◽  
Vol 26 (7) ◽  
pp. 889-897
Author(s):  
Aria Zand ◽  
Audrey Nguyen ◽  
Zack Stokes ◽  
Welmoed van Deen ◽  
Amy Lightner ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Care Pathway ◽  
Clinical Care ◽  
Patient Experiences ◽  
Inflammatory Bowel ◽  
Clinical Care Pathway

scholarly journals The Impact of Psychiatric Comorbidity on Health Care Utilization in Inflammatory Bowel Disease: A Population-based Study

2020 ◽  
Author(s):  
Charles N Bernstein ◽  
Carol A Hitchon ◽  
Randy Walld ◽  
James M Bolton ◽  
Lisa M Lix ◽  
...  
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Utilization ◽  
Bowel Disease ◽  
Psychiatric Comorbidity ◽  
Care Utilization ◽  
Physician Visits ◽  
Inflammatory Bowel ◽  
Hospital Days ◽  
The Impact

Abstract Background Inflammatory bowel disease (IBD) is associated with an increase in psychiatric comorbidity (PC) compared with the general population. We aimed to determine the impact of PC on health care utilization in persons with IBD. Methods We applied a validated administrative definition of IBD to identify all Manitobans with IBD from April 1, 2006, to March 31, 2016, and a matched cohort without IBD. A validated definition for PC in IBD population was applied to both cohorts; active PC status meant ≥2 visits for psychiatric diagnoses within a given year. We examined the association of active PC with physician visits, inpatient hospital days, proportion with inpatient hospitalization, and use of prescription IBD medications in the following year. We tested for the presence of a 2-way interaction between cohort and PC status. Results Our study matched 8459 persons with IBD to 40,375 controls. On crude analysis, IBD subjects had ≥3.7 additional physician visits, had >1.5 extra hospital days, and used 2.1 more drug types annually than controls. Subjects with active PC had >10 more physician visits, had 3.1 more hospital days, and used >6.3 more drugs. There was a synergistic effect of IBD (vs no IBD) and PC (vs no PC) across psychiatric disorders of around 4%. This synergistic effect was greatest for anxiety (6% [2%, 9%]). After excluding psychiatry-related visits and psychiatry-related hospital stays, there remained an excess health care utilization in persons with IBD and PC. Conclusion Inflammatory bowel disease with PC increases health care utilization compared with matched controls and compared with persons with IBD without PC. Active PC further increases health care utilization.

scholarly journals P326 An exploratory analysis of the impact of COVID-19 on colonoscopy procedures and new biologic treatment initiation among patients with Inflammatory Bowel Disease in the United States

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S350-S351
Author(s):  
R Ungaro ◽  
B Chou ◽  
J Mo ◽  
L Ursos ◽  
R Twardowski ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Claims Data ◽  
Clinical Care ◽  
The United States ◽  
Exploratory Analysis ◽  
Biologic Treatment ◽  
Inflammatory Bowel ◽  
New Treatment ◽  
The Impact

Abstract Background Patients with inflammatory bowel disease (IBD) require frequent colonoscopies to optimize disease management and treatment strategies. At the onset of the COVID-19 pandemic, many routine procedures were postponed to reduce the overall burden on healthcare systems. We characterized the impact of COVID-19 on IBD care by conducting an exploratory analysis of real-world US healthcare claims data to identify changes in treatment patterns and the number of colonoscopy procedures performed in patients with IBD during the first wave of the pandemic. Methods De-identified, open-source health insurance claims data, from Jan 2019 to Oct 2020, were obtained from the Symphony Health Integrated Dataverse® for US adults aged 18–80 years with IBD. Four outcome measures were used: number of colonoscopies performed; number of new biologic treatment initiations or treatment switches; number of new biologic treatment initiations or treatment switches in patients who had a colonoscopy within the previous 60 days; and rate of telehealth consultations per 1000 patients per month. Results During Jan–Dec 2019 and Jan–Oct 2020, 1.54 million and 1.29 million patients with IBD, respectively, were included. The bimonthly number of colonoscopies remained stable throughout 2019, with a maximum change of +5.4% in Jul–Aug (N = 49947) vs Jan–Feb 2019 (N = 47399). Colonoscopy use decreased by 4.7% in Jan–Feb 2020 (N = 45167) vs the same period in 2019. In Mar–Apr 2020, colonoscopy numbers decreased by 55.3% (N = 20191) vs Jan–Feb 2020 (Figure 1a); a reduction of 59.4% vs Mar–Apr 2019 (N = 49780). In May–Jun 2020 (−23.8%) and Jul–Aug 2020 (+2.0%) the difference vs Jan–Feb 2020 gradually decreased (Figure 1a). Bimonthly numbers of new treatment initiations or treatment switches in 2019 varied by up to 6.9% vs Jan–Feb 2019. In May–Jun 2020, numbers of new treatment initiations or treatment switches decreased by 17.0% (N = 10072) vs Jan–Feb 2020 (N = 12133) (Figure 1b); a decrease of 19.3% vs May–Jun 2019 (N = 12488). The number of new treatment initiations or treatment switches in patients who had a colonoscopy within the previous 60 days decreased by 42.5% (N = 892) in Mar–Apr 2020 vs Jan–Feb 2020 (N = 1551) (Figure 1c); a decrease of 44.2% vs Mar–Apr 2019 (N = 1599). Telehealth utilization increased in March 2020 and remained higher than in 2019 up to October 2020 (Figure 2). Conclusion Reduction in colonoscopies and subsequent initiation/switching of treatments during the COVID-19 pandemic first wave suggests lost opportunities for therapy optimization that may have an impact on longer-term patient outcomes. Increased utilization of telehealth services may have helped address gaps in routine clinical care.

scholarly journals N27 What people want! Exploring inflammatory bowel disease patients’ perspectives on healthcare professionals addressing sexual well-being

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S669-S670
Author(s):  
S Fourie ◽  
W Czuber-Dochan ◽  
C Norton
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Holistic Approach ◽  
Well Being ◽  
Structured Interviews ◽  
Time Space ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Inflammatory bowel disease (IBD) affects every aspect of one’s life, yet no routine assessment for the impact on sexuality is made. Our aim was to explore patients’ perspective on healthcare professionals (HCPs) addressing sexuality/sexual well-being concerns. Methods This was a qualitative narrative study. Inclusion criteria were any sexual orientation and with known IBD for longer than 18 months. Data were collected via semi structured interviews and anonymous narrative accounts submitted via Google Forms. Thematic analysis was used to analyse the data. Results Fourteen adults, 4 male and 10 female, took part. Eleven participants were from the UK, one from the USA of America and one for South Africa. The following main themes and subthemes were identified: I cannot imagine talking about my sex life (a difficult topic; there is not enough time), Those who talked about sex, talked badly (nobody volunteered information; badly handled conversations), Still living whilst unwell (sex is an important part of my life; sex issues break down relationships, medicalised body), IBD ruined my sex life (feeling unattractive; feelings of shame and embarrassment), I feel unheard (HCPs don’t open the discussion; sex not taken seriously), I’m a person, not my IBD (holistic approach to care; time, space and ways to talk about sex). The findings reflect the importance of sexual well-being to those living with IBD, the experiences of such conversations, barriers to conversations with HCPs on sexual well-being, and suggestions on how HCPs should address their unmet needs. The importance of discussing intimacy and sexuality was emphasised, as participants felt their sexual well-being was considerably affected by IBD. The majority reported that HCPs did not initiate discussions on sexual well-being, nor did they understand the impact of IBD on sexual well-being, with a distinct accent on the perceived lack of a holistic approach to their care. Therefore, participants made suggestions for practice, such as provision of information related to sexual well-being in the form of leaflets, additionally to HCPs raising the issue. Conclusion Our findings indicate that communicating on sexuality/sexual well-being is a problematic area of IBD care. HCPs must be cognisant of the sexual well-being concerns and needs of those living with IBD, who want this topic discussed routinely, as part of a holistic approach to their clinical care.

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