The Impact of the COVID-19 Pandemic on IBD Care in Alberta: Patient and Provider Perspectives

Abstract

Objective The COVID-19 pandemic necessitated changes in the delivery of ambulatory care for patients with inflammatory bowel disease (IBD), including transitioning many visits to virtual formats and delaying non-urgent assessments. We aimed to evaluate the impact of the COVID-19 pandemic on IBD patient care from health care providers’ (HCP) and patients’ perspectives. Methods We administered a 42-question HCP survey and a 44-question patient survey, which evaluated HCP and patient experience and satisfaction with care delivery and delays in access to IBD care during the first wave of the COVID-19 pandemic. Results Surveys were completed by 19.2% (24/125) HCPs and 25.8% (408/1581) patients. Overall, 82.7% of patients with IBD maintained their care without disruption. The majority of patients were satisfied with a transition to virtual care. All HCPs were willing to use virtual care in the future; however, 60% (14/24) of HCPs reported that virtual care was not equivalent to in-person visits. Patients reported concerns around access to health resources, the uncertainty of IBD-specific care, and fear and stress due to employment uncertainty and safety. Providers also reported concerns about patient safety, patient education, adequate remuneration and challenges with providing care for new patients on virtual platforms. Conclusion While some delays in health care delivery occurred during the first wave of the pandemic, both patients and HCPs were satisfied with a transition to new models of care delivery. These models may remain in place post-pandemic and allow for flexibility in care delivery that is acceptable to both patients and HCPs.

Integrating Virtual Mindfulness-Based Stress Reduction Into Inflammatory Bowel Disease Care: Mixed Methods Feasibility Trial

“…Moreover, a previous study of MBSR in the general population demonstrated similar attrition when comparing in-person delivery of MBSR with digital delivery [ 35 ]. In view of all 3 studies being conducted in different geographical locations and at different times, it is possible that the study populations differ in their comfort levels with telehealth; however, a recent survey of IBD patients in Alberta found that over 80% of respondents were comfortable using virtual care options and agreed they were satisfied with telehealth as a treatment modality [ 36 ], and a previous study in the same geographical area with a similar IBD population found no challenges with attrition [ 37 ]. While attrition observed in our study could reflect random variation arising from the small number of participants, future studies should investigate if v-MBSR groups are noninferior to in-person MBSR groups with respect to completion.…”

Scoping Review of Challenges and Existing Tools

“…Many of the selected articles in this review report difficulties in establishing trust and patient-provider relationships during video consultations. [17][18][19][20][21] The challenges reported in the literature can be grouped under two themes: (1) trust and physical distance, and (2) confidence in clinical assessment and embodied engagement.…”

“…22,23 Trust in the technology, trust in the patient performing a physical exam, and trust in the physician providing the best care are some of the patient and provider reported concerns. Patients experience challenges related to the complexity of scheduling appointments, 17 technical difficulties such as time lags that can cause a degree of talking over and affect the consultation, 15 limited access to technology or a lack of technical skills, 21,24,25 and the system security and privacy. [24][25][26] In the context of video consultations, trust is difficult due to compromised nonverbal communication, 18 the lack of physical touch, and the general feeling of loss experienced on both sides of the screen.…”

“…27 These include older adults, those with low socioeconomic status, 27 or those experiencing language barriers and hearing difficulties. 21,24,26 Moreover, the physical distance between patients and providers makes it difficult to establish a positive relationship. 17 Video consultations attenuate collaborative conversations, which leads to less trust.…”

“…18 However, when the virtual consultation requires a physical examination, both patients and providers find it challenging to trust the quality of the assessment. 17,19,24,27,28,32 The absence of physical examinations is a concern for patients, especially when symptomatic, 21 and they worry about errors in their care when the visit requires performing a physical examination. 19 Providers are also uncomfortable trusting physical examinations performed by patients.…”