Young persons and health care professionals experience of virtual gastroenterology consultations – a multicentre survey

OFR-1 Table 1Key findings YP HCP VC strengths Saved time 84% Saved money 78% Reduced travel 25% Improved access to healthcare 81% Useful appointment 87% Would like VC again 83% More efficient & convenient Don’t miss education/work Safer during COVID Spoke to YP directly 80% Saw more patients 23% More free admin time 23% Convenient Don’t always need clinic room VC barriers Poor WIFI Need extra appointment for investigations/to collect prescriptions Communication easier face to face Less private Patient had to come to hospital for tests post VC 77% Unable to speak to YP privately 69% Unable to contact patient 48% Information technology (I.T) problems 29% Difficulty arranging investigations 23% Suggested improvements Improve I.T Use video not phone Prefer face to face Improve I.T 86% Have YP present for VC Ability to speak to YP alone Having results ready and easily accessible Improved pathways for requesting tests ConclusionsOverall respondents were satisfied with VC and felt they were useful, convenient and saved time.The surveys highlighted that improved I.T for both staff and patients is vital. In addition, improved processes for requesting investigations, prescriptions and accessing results would minimise admin time for staff and extra appointments for patients.Direct engagement and privacy with YP was reported to be more difficult with VC, which is an important consideration in developmentally appropriate transitional healthcare. Some YP felt more comfortable discussing personal or complex issues face to face with a HCP that they knew.It is important to recognise patient preference for face to face or virtual clinics and personalise care accordingly, acknowledging that this may alter with time and circumstance.Successful virtual consultations rely on appropriate patient selection and availability of reliable WIFI and IT. Patient preference is key and this may alter with time.

Point-of-care faecal calprotectin testing in patients with paediatric inflammatory bowel disease during the COVID-19 pandemic.

OBJECTIVES: Following the disruption of normal paediatric inflammatory bowel disease (IBD) services during the peak of the COVID-19 pandemic, we prospectively audited the first-time use of home faecal calprotectin testing. We aimed to provide an alternative to laboratory tests and to assess the value of home testing as part of our regular services going forward. METHODS: Home test kits as well as accompanying user instructions were made available to our patients with paediatric IBD that required faecal calprotectin test between 17 April and 12 August 2020. Once the user completed the test, results were automatically uploaded to the result portal and clinical staff were alerted. A user feedback questionnaire was sent to users that had completed the home test. RESULTS: Of the 54 patients, 41 (76%) aged between 4.7 and 18.1 years used the home test. A total of 45 home tests were done, one of which produced an invalid result. The decision to modify management was made in 12 (29%) of the patients, while 14 (34%) had no changes made and 15 (37%) required further assessment. Twenty (48.8%) responded to the questionnaire and 85% stated that they preferred the home test to the laboratory testing method. CONCLUSIONS: Home calprotectin tests were useful in guiding clinical management during a time when laboratory testing was less available. They may offer benefits as part of routine paediatric IBD monitoring to help target appointments and reduce unnecessary hospital attendances in the future.

Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice.

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services. Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges. Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted. These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices. In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.