Activities related to inflammatory bowel disease management during and after the coronavirus disease 2019 lockdown in Italy: How to maintain standards of care

Abstract

Background and aims Restructuring activities have been necessary during the lockdown phase of the coronavirus disease 2019 (COVID-19) pandemic. Few data are available on the post-lockdown phase in terms of health-care procedures in inflammatory bowel disease (IBD) care, and no data are available specifically from IBD units. We aimed to investigate how IBD management was restructured during the lockdown phase, the impact of the restructuring on standards of care and how Italian IBD units have managed post-lockdown activities. Methods A web-based online survey was conducted in two phases (April and June 2020) among the Italian Group for IBD affiliated units within the entire country. We investigated preventive measures, the possibility of continuing scheduled visits/procedures/therapies because of COVID-19 and how units resumed activities in the post-lockdown phase. Results Forty-two referral centres participated from all over Italy. During the COVID-19 lockdown, 36% of first visits and 7% of follow-up visits were regularly done, while >70% of follow-up scheduled visits and 5% of first visits were done virtually. About 25% of scheduled endoscopies and bowel ultrasound scans were done. More than 80% of biological therapies were done as scheduled. Compared to the pre-lockdown situation, 95% of centres modified management of outpatient activity, 93% of endoscopies, 59% of gastrointestinal ultrasounds and 33% of biological therapies. Resumption of activities after the lockdown phase may take three to six months to normalize. Virtual clinics, implementation of IBD pathways and facilities seem to be the main factors to improve care in the future. Conclusion Italian IBD unit restructuring allowed quality standards of care during the COVID-19 pandemic to be maintained. A return to normal appears to be feasible and achievable relatively quickly. Some approaches, such as virtual clinics and identified IBD pathways, represent a valid starting point to improve IBD care in the post-COVID-19 era.

Impact of the COVID-19 pandemic on inflammatory bowel disease patients: A review of the current evidence

“…There is a scarcity of data regarding the post-lockdown phase in terms of health-care procedures[ 91 , 92 ], let alone in the IBD population[ 93 - 96 ]. Early into the pandemic, hospitals were urged to restructure their daily activities to meet the needs of health care practitioners and to provide the facilities to treat COVID-19 patients.…”

“…The restructuring of the health care system did not circumvent IBD management. Consequently, the risks of secondary harm emerged, as the latter resulted in reduced access to diagnostic endoscopy, lack of face-to-face clinics, difficulties in continuing day-case infusions, issues in performing routine blood and/or stool monitoring as well as patients' fears which may have reduced their attendance in hospitals[ 93 ]. Particular problems emerged in the pediatric population, since a delay in diagnosis and delayed treatment has the potential to result in serious repercussions, such as an impact on children’s growth[ 97 , 98 ].…”

“…Particular problems emerged in the pediatric population, since a delay in diagnosis and delayed treatment has the potential to result in serious repercussions, such as an impact on children’s growth[ 97 , 98 ]. Recent Italian and Spanish surveys both demonstrated that the management of urgent activities and administration of biological therapies in both the lockdown and post-lockdown periods substantially maintained the pre-pandemic standards of care[ 93 , 94 ]. However, the surveys also highlighted that the reduction in number of visits, endoscopies and gastrointestinal ultrasounds observed in the lockdown but also in the post-lockdown phase could result in worse long-term outcomes[ 93 , 94 ].…”

Management of patients with inflammatory bowel disease and outcomes during the first wave of the Covid-19 pandemic

“…Most former reports related to the Covid-19 pandemic investigated organizational adaption to the changing situation or on disease outcome in case of SARS-CoV-2 infection in IBD patients. [ 3 , 4 ]…”

No impact of restructuring IBD-related activity during COVID-19 outbreak on patient outcomes. A single Center experience

“…In Italy, a substantial change of practice has been recorded in most Gastroenterology Units through the entire country: although urgent and emergent services have been generally guaranteed, outpatient consultations, endoscopic and ultrasound procedures have been significantly reduced and limited to urgencies and oncologic indications [1] . The restructuring of clinical activities also affected inflammatory bowel disease (IBD) units, most of them temporarily stopped and postponed non-urgent activities and implemented virtual follow-up clinics (telemedicine, phone calls and/or Email consultation) in order to reduce the risk of viral transmission while maintaining the minimum standard of IBD care [2] .…”