Evaluation of factors associated with trust in telemedicine in patients with inflammatory bowel disease during COVID-19 pandemic: a multicenter cross-sectional survey.

OBJECTIVE: Telemedicine (TM) has had a powerful impact in recent years, particularly on managing chronic diseases such as inflammatory bowel disease (IBD). Knowing patients' expectations and concerns is essential to increase their confidence in this mode of medical care. PATIENTS AND METHODS: We interviewed a large cohort of IBD patients enrolled at two Italian tertiary referral centers to investigate their trust in TM. RESULTS: A total of 376 patients completed the survey and were included in the study: 293 (77.9%) considered TM valuable for managing their disease, and 307 (85%) wanted to have TM service at their center. However, only 99 patients (26.3%) believed that TM guarantees the same level of care as the in-person visit. Among the socio-demographic variables, those independently associated with trust in TM were the higher education qualification (p=0.02) and the level of competence in information and communication technologies (ICT) (p=0.03). CONCLUSIONS: Our findings highlighted the importance of equipping IBD patients with basic ICT skills to utilize TM services and increase their confidence in ICT with the help of caregivers. Additionally, to improve the perceived value of TM, it will be helpful to use additional tools such as telemonitoring of disease activity using patients' reported outcomes or remote measurement of fecal calprotectin.

Willingness and hesitancy to the telemedicine in patients with inflammatory bowel disease during COVID-19 outbreak. Preliminary results of a survey in an Italian IBD Center

Background: Telemedicine is becoming a necessary tool for chronic disease management. Thanks to the wide diffusion of devices connecting to the World Wide Web, a large part of the population are now able to access to telemedicine services.Telemedicine is becoming a necessary tool for chronic disease management. Thanks to the wide diffusion of devices connecting to the World Wide Web, a large part of the population are now able to access to telemedicine services. The aim of this survey was to explore the willingness and hesitancy of patients with inflammatory bowel disease (IBD) to the use of telemedicine during COVD-19 outbreak. Methods: A paper-and-pencil questionnaire was proposed to all consecutive patients observed at our tertiary IBD center in San Giovanni Rotondo (Italy) from February to May 2021. The survey investigated 20 items that can be grouped into 5 areas: socio-demographic data, clinical data, informatics competence, devices and network utilized for the internet connection, attitude to the telemedicine, and the impact of COVID-19 pandemic. Results: A total of 156 patients completed the questionnaire (100 males). One hundred forthy-three patients (91.7%) were under 65 years and only 15 (9.6%) were graduates. Forthy-seven patients (30%) were single, 101 married (65%). Eighteen patients (11.5%) felt they had no IT skills. Eight patients (5.1%) had a previous experience of telemedicine. One hundred twenty-three patients (78.8%) consider the support of telemedicine useful for the management of their pathology and 134 (85.9%) would like the Center where they are followed up to have the possibility of offering a telemedicine service. One hundred three patients (66.0%) would like to have a teleconsultation with figures other than the Gastroenterologist. Ninety-seven patients (62.2%) agree that the ongoing coronavirus pandemic has a major impact on the need to implement telemedicine. Regarding the confidence with telemedicine, 106 patients (67.9%) were partially or totally agreeing telemedicine can properly resolve health problems, and 98 (62.8%) agree that technologies guarantee the privacy of the health data. One hundred twenty-five patients (80%) agree that telemedicine should be developed independently of the pandemic, however only 48 patients (31%) believe that telemedicine guarantee the same level of assistance of visit in presence. Conclusion: Italian IBD patients showed a positive attitude towards telemedicine and consider that useful for the management of their disease. The majority of patients would like the center where they are followed up offering a telemedicine service, regardless of the ongoing pandemic. However only one third of patients believe that telemedicine can offer the same level of assistance of in-presence visit.

Increased risk of ibd flare after sars-cov-2 infection. Whos the more guilty: Viral infection or therapy withdrawal?

Background: In the last year, the severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has spread rapidly around the world. The interactions between SARS-CoV-2 and inflammatory bowel disease (IBD) are so far not fully understood. In particular, no studies evaluated the potential role of SARS-CoV-2 on IBD course. Indeed, it is known that viral infections can be act as triggers for IBD flare and it is reasonable that the possible drug discontinuation during SARS-CoV-2 infection could in turn lead to an IBD flare. Methods: This was a prospective, observational case-control study. From March 11th 2020 to June 30th 2020 we enrolled IBD patients with proven SARS-Cov-2 infection (cases) and IBD patients without SARS-CoV-2 infection matched for sex, age, diagnosis, therapy and clinical activity (controls). Cases and controls were followed-up at least for 6 months. Differences between case and control group were tested for significance using the Students t test and Fishers test, as appropriate. A two-tailed p value < 0.05 was indicative of statistical significance. Results: 219 IBD patients (127 UC, 58.0%) with SARS-CoV-2 infection and 219 IBD patients without SARS-CoV-2 infection were enrolled. Table 1 shows baseline features of the population. Among the 122 cases in clinical remission at the time of viral infection, 28 (22.9%) showed a disease flare;this percentage was significantly higher than that observed in controls: 12/137 (8.8%)(p=0.0018). Among patients with disease flare, there were no significant differences between cases and controls group in terms of age (42.3 ± 16.0 vs. 43.1 ± 15.4 years, p=0.44), gender (female 45.7% vs. 48.2%, p= 0.54), use of biologic therapies (p=0.83) and UC or CD diagnosis (p=0.06). Biologic therapy was temporary withdrawn more significantly in cases than in controls (68/202, 33.6% vs. 14/204, 6.9%) (p<0.001) and overall biologic therapy discontinuation was significantly associated with disease flare (OR 2.56, 95% CI 1.026.41, p=0.04). Conclusion: IBD patients with SARS-CoV-2 infection have an increased risk to have a clinical recurrence in short-term in comparison with IBD patients without SARS-CoV-2 infection. This increased risk could be due to the viral infection and/or to the temporary discontinuation of biologic therapies, because of infection.

Worse impact of second wave COVID-19 pandemic in adults but not in children with inflammatory bowel disease: an Italian single tertiary center experience.

OBJECTIVE: From September 2020, a second wave of COVID-19 pandemic started. We aimed at exploring the impact of SARS-CoV-2 infection in IBD patients during the two waves. PATIENTS AND METHODS: All IBD patients with a confirmed diagnosis of SARS-CoV-2 infection were enrolled. They were sorted into two groups (those infected before September 2020, and those from September 2020 to January 2021) and compared by demographic and clinical data. RESULTS: Twenty-five patients (out of about 600 with a follow-up visit) were infected with SARS-CoV-2 (4.1%). Sixteen were male and the mean age was 46.5 ± 14.3 years (range 24-74). Six were smokers and 11 had comorbidities; 2 were on steroids and 17 on immunosuppressants or biologics. Three patients (12%) needed hospitalization and other three patients were treated with azithromycin, steroids and LMWH, all of them during the second wave. No patient died or developed any sequelae. Two subjects were infected during the first wave (0.3 vs. 3.83, p<0.0001). Non-significant differences were found between the two groups. CONCLUSIONS: A higher number of IBD patients were infected during the second wave. No patient developed a severe form of pneumonia, even those treated with immunosuppressants or biologics. No risk factor for hospitalization was found.