Letter: Covid‐19—re‐initiating clinical services for chronic gastrointestinal diseases. How and when?

Short abstract

LINKED CONTENT

This article is linked to Al‐Ani et al and Prentice et al papers. To view these articles, visit https://doi.org/10.1111/apt.15779 and https://doi.org/10.1111/apt.16065

We read with interest the review by Al‐Ani regarding the prevention and management of Covid‐19 in inflammatory bowel disease (IBD) patients. ¹ They recommended avoidance of healthcare facilities and telehealth appointments to prevent viral transmission. This, along with British Society of Gastroenterology (BSG) guidelines ² and position statements from the British Association for the Study of Liver disease, ³ have directed large cohorts of patients with chronic gastrointestinal disorders into enhanced social distancing or indeed shielding. The effectiveness of this strategy and adherence to guidelines among this patient group is, however, unknown. Moreover, recommendations for shielding or social distancing, allied with scant clinical resources, have resulted in limited access to disease monitoring with clinic consultations, phlebotomy, diagnostic radiology and endoscopy for these patients. Many clinical services rapidly switched to telephone consultations. As we recover from the pandemic, clinical services are now focused on the recovery phase and re‐initiation of services. The BSG recently issued guidance on re‐initiating out‐patient services with a particular emphasis on the use of digital technology and remote consultations. ⁴

Despite the rapid and widespread adoption of virtual consultations, patient acceptance of such strategies is poorly understood. We conducted a survey among IBD and liver disease patients taking immunomodulatory drugs to evaluate effectiveness and adherence to social distancing and shielding advice and to assess patient preferences for out‐patient follow‐up in the context of a pandemic.

We surveyed 195 patients with high risk chronic gastroenterological conditions (Table 1). Both adherence and effectiveness were high: 89% adhered to guidelines, and prevalence of Covid‐19 symptoms was low. Only 9% of patients reported symptoms that they felt were consistent with Covid‐19 and only 1.1% tested positive (self‐reported). While shielding and social distancing were effective for high risk patients, there is now a need for patients to re‐engage with clinical services and resume chronic disease management.

Table 1.

Characteristics of included subjects and preferences for modality of out‐patient follow‐up

	Autoimmune hepatitis (N = 27)	OLT (N = 70)	Cirrhosis (N = 65)	IBD (N = 33)
Age, median (range)	65 (18‐85)	59 (17‐83)	64 (39‐86)	48 (19‐80)
Gender, male %	15	47	53	42.4
Medications
Thiopurines	19	12	N/A	7
Methotrexate	0	0	N/A	3
Mycophenolate	5	25	N/A
Calcineurin inhibitors	2	60	N/A	0
5‐ASA	N/A	N/A	N/A	6
Corticosteroids	12	17	N/A	0
Vedolizumab	N/A	N/A	N/A	3
Adalimumab	N/A	N/A	N/A	7
Anti‐TNF agents	N/A	N/A	N/A	11
Ustekinumab	N/A	N/A	N/A	6
Percentage satisfaction for modality of follow‐up
Asynchronous consultation	82 (22)	79 (55)	71 (46)	88 (29)
Patient Portal	78 (17)	83 (58)	68 (44)	85 (28)
Telephone Consultation	89 (24)	83 (58)	75 (49)	88 (29)
Video Consultation	63 (17)	74 (52)	43 (28)	76 (25)

Patients’ overall satisfaction rated on a Likert scale of 0‐10 for different models of out‐patient clinic follow‐up. Results were categorised as 0‐3 = dissatisfied, 4‐7 = neutral and 7‐10 = satisfied.

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Patients were keen to engage with novel methods of follow‐up, with 85% wishing to have a virtual consultation when possible and 91% willing to attend for blood tests or scans and to weigh themselves in advance of an appointment (Table 1).

Furthermore, 75% were at least satisfied with a model of care that involved receiving feedback on their results from the clinical team by email or text; this increased to 80% with the addition of a telephone consultation to the care model. The addition of video consultations to the model of care was not important to patients; only 61% were at least satisfied when video consultation was added to the care model.

The issue of re‐starting services is becoming increasingly important as we move to the recovery stage of the pandemic. Our data indicate that patients with chronic gastrointestinal disorders are willing to adopt newer technologies for clinical consultations.