scholarly journals Insight from patients and healthcare professionals on the implementation of virtual clinics in patients with inflammatory bowel disease

2021 ◽  
pp. flgastro-2020-101714
Author(s):  
Aditi Kumar ◽  
Mohammed Nabil Quraishi ◽  
Shanika de Silva ◽  
Nigel John Trudgill ◽  
Helen Steed ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Healthcare Professionals ◽  
Telephone Consultation ◽  
Face To Face ◽  
Short Answer ◽  
Inflammatory Bowel ◽  
The Uk ◽  
Short Answer Questions ◽  
The Impact

IntroductionDuring COVID-19, the management of outpatient inflammatory bowel disease (IBD) changed from face-to-face (F2F) to telephone and video consultations across the UK. We surveyed patients with IBD and IBD healthcare professionals (HCPs) to evaluate the impact of this abrupt transition on patient and HCP satisfaction outcomes, including the barriers and enablers of this service.MethodsPatient satisfaction surveys were sent to patients who had a telephone consultation from May to July 2020. A second survey was sent to IBD HCPs across the UK. Questions from both surveys consisted of a mixture of multiple-choice options, ranking answers as well as short-answer questions.Results210 patients and 114 HCPs completed the survey. During COVID-19, there was a significantly greater use of telephone, video or a mixture of consultation. F2F consultations were consistently preferred by patients, with 50% of patients indicating they did not want the option of for video consultations. Patients were more likely to prefer a telephone consultation if they were stable and needed routine review. Significantly fewer HCPs (5.3%) intend to use F2F consultations alone, preferring the use of telephone (20.2%) or combinations of telephone/F2F (22.8%), telephone/video (4.4%) or combination of all three consultation types (34.2%). 63% indicated they intend to incorporate video consultations in the future.ConclusionTelephone and video consultations need to be balanced proportionately with F2F clinics to achieve both patient and HCP satisfaction. Further research needs to be done to explore the use of video medicine in patients with IBD.

scholarly journals Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic

2020 ◽  
Vol 11 (5) ◽  
pp. 343-350 ◽  
Author(s):  
Nicholas A Kennedy ◽  
Richard Hansen ◽  
Lisa Younge ◽  
Joel Mawdsley ◽  
R Mark Beattie ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Elective Surgery ◽  
Quality Care ◽  
Faecal Calprotectin ◽  
Telephone Consultation ◽  
Ensure Patient Safety ◽  
Inflammatory Bowel ◽  
The Uk ◽  
The Impact

ObjectiveTo determine the challenges in diagnosis, monitoring, support provision in the management of inflammatory bowel disease (IBD) patients and explore the adaptations of IBD services.MethodsInternet-based survey by invitation of IBD services across the UK from 8 to 14 April 2020.ResultsRespondents from 125 IBD services completed the survey. The number of whole-time equivalent gastroenterologists and IBD nurses providing elective outpatient care decreased significantly between baseline (median 4, IQR 4–7.5 and median 3, IQR 2–4) to the point of survey (median 2, IQR 1–4.8 and median 2, IQR 1–3) in the 6-week period following the onset of the COVID-19 pandemic (p<0.001 for both comparisons). Almost all (94%; 112/119) services reported an increase in IBD helpline activity. Face-to-face clinics were substituted for telephone consultation by 86% and video consultation by 11% of services. A variation in the provision of laboratory faecal calprotectin testing was noted with 27% of services reporting no access to faecal calprotectin, and a further 32% reduced access. There was also significant curtailment of IBD-specific endoscopy and elective surgery.ConclusionsIBD services in the UK have implemented several adaptive strategies in order to continue to provide safe and high-quality care for patients. National Health Service organisations will need to consider the impact of these changes in current service delivery models and staffing levels when planning exit strategies for post-pandemic IBD care. Careful planning to manage the increased workload and to maintain IBD services is essential to ensure patient safety.

scholarly journals Impact of COVID-19 on diagnosis and management of paediatric inflammatory bowel disease during lockdown: a UK nationwide study

2020 ◽  
Vol 105 (12) ◽  
pp. 1186-1191 ◽  
Author(s):  
James John Ashton ◽  
Jochen Kammermeier ◽  
Christine Spray ◽  
Richard K Russell ◽  
Richard Hansen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Healthcare Provision ◽  
Exclusive Enteral Nutrition ◽  
Face To Face ◽  
Inflammatory Bowel ◽  
Histological Confirmation ◽  
The Uk ◽  
The Impact

BackgroundCOVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic.MethodsFor the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD.ResultsAll centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres.ConclusionsDiagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.

scholarly journals P136 Management of patients with Inflammatory Bowel Disease and their outcome during the first wave of Covid-19 pandemics

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S223-S224
Author(s):  
A Viola ◽  
F Giambò ◽  
M F Chiappetta ◽  
G Costantino ◽  
S Pallio ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Secondary Outcome ◽  
Reference Period ◽  
Disease Flare ◽  
Face To Face ◽  
Risk Of Disease ◽  
Inflammatory Bowel ◽  
Group 2 ◽  
The Impact

Abstract Background The restrictions adopted in Italy during the phase I COVID-19 pandemics with a nationwide lockdown period, represented a challenge in the management of Patients with Inflammatory Bowel Disease (IBD) patients. The aim of the present study was to assess if, and how, a limited course of telemedicine did influence the clinical outcome in patients with Crohn’s disease (CD) and Ulcerative Colitis (UC). Methods IBD patients followed before March 8th, 2020 were included and divided into 3 groups (Fig.1): group 1, patients on endovenous biologics (EV); group 2, patients on biologics administered subcutaneously (SC); and group 3, patients on conventional treatments (CT) at the start of lockdown. The primary outcome was to assess the occurrence of disease flare in the three groups since only the EV group received face-to-face visits during lockdown. As secondary outcome we assessed the number of control endoscopies performed and the start of new biologic therapies, compared with a reference period in 2019. Results A total of 689 patients (CD: 369, UC 320) were included in the study (247 IV, 217 SC and 225 CT, respectively). Telemedicine was more frequently adopted in SC and CS, (p&lt;0.001) both. Treatment delays or transitory stops were more frequent in EV (p&lt;0.001), whereas there was a significantly greater need to change therapy (p= 0.038) and need for steroids (p = 0.008) in the SC group compared with EV (Tab.1). Concerning endoscopies, compared with the reference period in 2019 only 25% of scheduled endoscopies were performed. The only risk factor for disease flare during or shortly after lockdown was belonging to the patient groups subjected to telemedicine (SC and CT groups) (p &lt; 0.001). Conclusion Patients followed with a face-to-face approach instead of telemedicine, had a lower risk of disease flare during lockdown period. The impact of the important reduction of endoscopic assessments still needs to be assessed.

scholarly journals Specialist inflammatory bowel disease nursing in the UK: current situation and future proofing

2020 ◽  
pp. flgastro-2019-101354 ◽  
Author(s):  
Lisa Younge ◽  
Isobel Mason ◽  
Rukshana Kapasi
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Formal Education ◽  
Clinical Nurse Specialists ◽  
Nursing Services ◽  
Business Cases ◽  
Inflammatory Bowel ◽  
Specialist Nurses ◽  
The Uk ◽  
The Impact

ObjectiveTo determine the impact to date of the ongoing Crohn’s & Colitis UK inflammatory bowel disease (IBD) clinical nurse specialists (CNS) campaign.MethodsA survey-based design was used. 2 questionnaires were sent to the UK IBD nursing community and promoted via nursing and clinical networks. Respondents were asked to provide data at both an individual and trust level about their nursing services.Results394 IBD CNS posts were identified across the UK, with a 32% increase in posts since the start of the campaign. 27% felt the campaign had been influential in securing new posts. Greater numbers of posts were reported in England when compared with the devolved nations. Most services remain below the UK standards recommendation of 2.5 IBD CNS per 250 000 patient population. Cross site working was reported in 59% of services. 45% of respondents were non-medical prescribers, with 13% educated to MSc level. High levels of stress were reported by IBD CNS associated with managing advice line services.ConclusionsCrohn’s & Colitis UK’s ‘More IBD Nurses–Better Care’ campaign has contributed to the numbers of CNS posts in IBD continuing to rise, but they remain lower than the recommended standard of 2.5 IBD CNS per 250 000. Educational and career pathways are not clearly defined, and aspects of the role such as advice line provision contribute to stress within the workforce. The ongoing aims of the charity campaign hope to address these issues by improving access to formal education pathways with peer support for IBD specialist nurses, and advice line training, in addition to supporting trusts and services throughout the UK to reduce the workforce deficit with effective business cases.

scholarly journals N19 Understanding the emotional impact of inflammatory bowel disease: looking after nurses looking after patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S666-S666
Author(s):  
L Younge ◽  
L Medcalf ◽  
A Hall ◽  
C Shaw
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Psychological Impact ◽  
Well Being ◽  
Emotional Impact ◽  
Learning Needs ◽  
Emotional States ◽  
Inflammatory Bowel ◽  
The Uk ◽  
The Impact

Abstract Background The emotional impact of inflammatory bowel disease (IBD) is well documented. Patients describe distress, anxiety, depression and relationship difficulties, (including with healthcare staff). Nurses working with IBD patients report being emotionally affected, with fears of ‘burnout’, feeling unable to respond helpfully to patients and feelings of guilt, frustration, sadness and anger. Understanding and managing the emotional impact of the work for IBD nurses is an area underrepresented in either research or nursing literature. Methods A collaborative project with IBD nurses and nursing and psychotherapy colleagues from the Tavistock and Portman NHS Foundation Trust developed a one-day event for IBD nurses in the UK. Attendees were self-selecting and the event was supported by Pharma. The conference had three aims: To provide an opportunity to recognise and understand the emotional impact on nurses working with IBD patients, to provide a networking opportunity, and to use information gathered before, during and after the conference to develop a clearer understanding of nurses’ experiences and needs. A pre-conference questionnaire was sent to attendees, observations were made during the conference (noting themes and dilemmas) and an evaluation form was provided. Results 89% agreed/strongly agreed the event provided understanding of how IBD can have an emotional and psychological impact on patients. 89% agreed/strongly agreed the event provided understanding of the emotional impact on nurses working with IBD patients. Eighty-nine per cent agreed/strongly agreed the event provided understanding of ways in which the emotional impact can influence provision of care and decision making in patients with IBD. Ninety-three per cent agreed/strongly agreed the event provided them with ideas for establishing and managing reflective learning opportunities. Seventy-five per cent agreed/strongly agreed the event enabled them to identify different ways of responding to patients they work with. Conclusion Feedback from attendees identified a need and an expressed wish by IBD nurses to understand and explore how they are affected by their work, in relation to maintaining therapeutic and safe relationships with patients and maintaining their own well-being and job satisfaction. Learning needs relating to training in supervision, developing skills in responding to patients’ emotional states, tools for looking after one’s self and opportunities for group discussions and learning were identified. There is an opportunity to develop further learning and training events in relation to these identified needs. Further exploration of accessibility, funding and evaluation would be beneficial in identifying the impact, if any, of further training.

scholarly journals COVID-19-related health anxieties and impact of specific interventions in patients with inflammatory bowel disease in the UK

2020 ◽  
pp. flgastro-2020-101633
Author(s):  
Nasir Mir ◽  
Jonathan Cheesbrough ◽  
Thomas Troth ◽  
Nasir Hussain ◽  
Laurence Joseph Hopkins ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Information Seeking ◽  
Information Dissemination ◽  
Risk Groups ◽  
Health Related ◽  
Inflammatory Bowel ◽  
The Uk ◽  
Clinical Interactions ◽  
The Impact

ObjectiveHealth-related concerns brought on by the COVID-19 pandemic and the impact of specific local and national interventions have not been explored in patients with inflammatory bowel disease (IBD) in the UK. We evaluated perspectives of patients with IBD on the pandemic and effectiveness of information dissemination in addressing concerns.MethodsWe prospectively conducted a survey among patients with IBD during the COVID-19 pandemic to assess concerns, information-seeking behaviours, risk perception, compliance and effect of specific interventions.ResultsA total of 228 patients were interviewed of whom 89% reported being concerned about the impact of COVID-19 on their health. Access to at least one IBD-specific clinical interaction during the pandemic (COVID-19 information letter from IBD team, interaction with IBD team or general practitioner, Crohn and Colitis UK website visit) was significantly associated with alleviating concerns (OR 2.66; 95% CI 1.35 to 5.24; p=0.005). Seeking health information solely through unofficial channels (search engines or social media) was less likely to ease concerns (OR 0.15; 95% CI 0.03 to 0.61; p=0.008). A quarter of patients disagreed with their assigned risk groups, with majority perceiving higher-risk profiles. This discordance was greatest in patients within the moderate-risk group and constituted immunosuppression use. Nearly 40% of patients had ongoing concerns with regard to their medications of whom a third felt their concerns were not addressed.ConclusionIBD-specific clinical interactions are associated with alleviation of COVID-19 health concerns. These findings have wider implications and emphasise importance of innovative solutions that facilitate effective communication with patients without overburdening current services.

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.

scholarly journals Dietary beliefs and recommendations in inflammatory bowel disease: a national survey of healthcare professionals in the UK

2020 ◽  
pp. flgastro-2020-101723
Author(s):  
Benjamin Crooks ◽  
John McLaughlin ◽  
Jimmy Limdi
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Healthcare Professionals ◽  
Gastrointestinal Symptoms ◽  
Red Meat ◽  
Dietary Advice ◽  
Dietary Recommendations ◽  
Inflammatory Bowel ◽  
Dietary Components ◽  
The Uk

BackgroundThe role of diet in inflammatory bowel disease (IBD) remains incompletely understood. Knowledge around the actual dietary advice healthcare professionals provide to individuals with IBD is scarce. Our objective was to describe the dietary beliefs of healthcare professionals and dietary recommendations made to people with IBD.MethodologyAn online survey regarding IBD-related dietary beliefs and advice provided to patients was distributed to gastroenterologists, dietitians and IBD nurses in the UK.ResultsTwo-hundred and twenty-three eligible healthcare professionals participated: 107 (48%) believed that diet was involved in IBD development. The most frequently implicated dietary components were processed foods (78%), additives/preservatives (71%), sweet/sugary foods (36%), red meat (36%) and fatty foods (31%). Views were broadly consistent across professions, however, gastroenterologists were significantly more likely to believe red meat and additives/preservatives initiated IBD. One hundred and thirteen participants (53%) believed that diet could trigger disease relapse and 128 (61%) recommended limiting specific foodstuffs to reduce this risk, most commonly high fibre foods. Forty-six (23%) considered recommending a low Fermentable Oligo-, Di- and Monosaccharides and Polyols diet to reduce relapse risk. IBD nurses and healthcare professionals with <5 years experience were most likely to recommend this. Dietitians felt most comfortable providing dietary advice for functional gastrointestinal symptoms in quiescent IBD.ConclusionDietary advice in IBD is inconsistent reflecting uncertainty among healthcare professionals. While some consensus exists regarding dietary components implicated in IBD development and relapse, dietary recommendations varied. Future research is required to disentangle these complex relationships, alongside better training and education.

Review of a paediatric inflammatory bowel disease service during the pandemic and the impact of the CNS role

2021 ◽  
Vol 30 (14) ◽  
pp. 840-844
Author(s):  
Gemma Lee ◽  
Jochen Kammermeier ◽  
Rakesh Vora ◽  
Mohamed Mutalib
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Recovery Phase ◽  
Clinical Nurse ◽  
Face To Face ◽  
Clinical Notes ◽  
Clinical Nurse Specialists ◽  
The World ◽  
Inflammatory Bowel ◽  
The Impact

Background: Inflammatory bowel disease (IBD) is a chronic relapsing and remitting condition. The COVID-19 pandemic has severely disrupted provision of medical care across the world. IBD clinical nurse specialists (CNSs) played a pivotal role in the care of children with IBD during the pandemic national lockdown and in the recovery phase. This article aims to look at the impact of COVID-19 on the paediatric IBD service in one children's hospital and the effect on the IBD CNSs' workload. Method: A retrospective review of clinical notes and the service's IBD database from January 2019 to September 2020. Results: There was a significant increase in the number of email and telephone contacts to the IBD CNS team during lockdown. There was an increase in virtual clinics, and an increase in new IBD patients coming to the service, but a reduction in the number of face-to-face consultant clinics. Conclusion: COVID-19 has disrupted medical services to children with IBD and led to a reduction in face-to-face activities but has also led to a significant increase in virtual activities. CNSs have taken up a wider role to cover patient care during a time of both medical and nursing redeployment.

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