LINKING PRIMARY AND SPECIALTY CARE FOR THE MANAGEMENT OF DIGESTIVE HEALTH CONDITIONS: AN EVALUATION OF GUT LINK IMPLEMENTATION

Background: Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions. Aims: To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service. Methods: This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%). Results: A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%). been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI. Conclusions: The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways.

RAPID IMPLEMENTATION OF AN EVIDENCE-BASED, VIRTUAL COVID-19 VACCINE EDUCATION CLINIC AT THE NOVA SCOTIA COLLABORATIVE INFLAMMATORY BOWEL DISEASE CLINIC (NSCIBD)

Background The COVID-19 global pandemic has been associated with significant morbidity and mortality. Rapid adaptation of approaches to clinical management as well as policy decisions in relation to implementation of vaccination programs for persons living with IBD has been required throughout the pandemic. To meet the sudden demand of large scale public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtualCOVID-19 vaccine educational intervention was developed, implemented, and evaluated. Methods This was a prospective, observational, cross sectional, implementation-effectiveness study conducted at the NSCIBDprogram between April-July 2021. The educational intervention consisted of a standardized email outlining evidence relating to risks and benefits of COVID-19 vaccinations. The intervention was offered to all patients contacting the NSCIBD program with questions or concerns about the vaccine. During one-on-one virtual visits, standardized and evidence-basedinformation was provided by a gastroenterologist or IBD nurse practitioner. Following the session, an anonymous questionnaire (NoviSurvey) evaluated key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, willingness to participate in future sessions, and recommendations for improvement. Descriptive analyses were conducted, with group means expressed as proportions for categorical variables and means for numerical variables. Results A total of 265 patients were invited to participate in the online survey, with a response rate of 49% (131/265). Before the session, 48.9% (64/131) expressed COVID-19 vaccine hesitancy and 26% (35/131) expressed concerns relating to risks versus benefits of COVID-19 vaccines. Ninety-one percent (119/ 131) of respondents found the education program to be helpful and 92% (121/131) indicated there was no information perceived to be lacking from the session. Following the intervention, the proportion of those willing to get vaccinated rose from 61% to 86.3%. Only 1.5% (2/ 131) indicated that they would likely not get vaccinated. Most participants (77%, 101/131) found the written and virtually administered educational content to be satisfactory and 88% (115/131) were willing to participate in similar virtual education offerings in the future. Conclusion Implementation of an evidence-based, multidisciplinary COVID-19 vaccination education intervention delivered using a virtual platform was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed.

In the Eye of the Beholder: Perspectives of Fellowship Applicants on Virtual Interviews

INTRODUCTION: The COVID-19 pandemic shifted many inperson activities to virtual settings. Given nationwide travel restrictions and recommendations from the Association of American Medical Colleges, subspecialty program directors for obstetrics and gynecology conducted interviews using a virtual platform for 2020. The impact of virtual interviews (VI) on a candidates' ability to effectively create a rank list is unknown. The primary objective was to evaluate obstetrics and gynecology subspecialty fellowship applicants' perspectives regarding the effectiveness of VI for creating a rank list. Secondary outcomes included perceived advantages and disadvantages of the process, including preference of interview type, cost, and time savings. METHODS: This was a cross-sectional electronic survey administered to a convenience sample of obstetrics and gynecology subspecialty applicants. This institutional review board-exempt survey was administered via REDCap. Descriptive statistics were used. RESULTS: Response rate was 158 of 330 (48%). Nearly all (99%) applicants cited cost savings as a distinct advantage of VI. Overall, 82% percent of respondents felt confident in making their rank list based on the VI, and 92% were “very satisfied” or “somewhat satisfied” with the process. Most respondents (91%) preferred Zoom to other virtual platforms. Of those who expressed an interview style preference (in-person versus VI), 44% of respondents preferred VI;33% had no preference or were not sure. CONCLUSION: The majority of applicants to obstetrics and gynecology subspecialty fellowships felt confident to create a rank list based on VI. This study indicates that the virtual format is suitable for fellowship interviews and can be utilized beyond the pandemic to improve equity and diversity in the applicant pool.

Rapid implementation of an evidence-based, virtual COVID-19 vaccine education clinic at the nova scotia collaborative inflammatory bowel disease clinic (NSCIBD) Program

Background: The COVID-19 global pandemic has been associated with significant morbidity and mortality. Rapid adaptation of approaches to clinical management as well as policy decisions in relation to implementation of vaccination programs for persons living with IBD has been required throughout the pandemic. To meet the sudden demand of large scale public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtual COVID-19 vaccine educational intervention was developed, implemented, and evaluated. Methods: This was a prospective, observational, cross sectional, implementation-effectiveness study conducted at the NSCIBD program between April-July, 2021. The educational intervention consisted of a standardized email outlining evidence relating to risks and benefits of COVID-19 vaccinations. The intervention was offered to all patients contacting the NSCIBD program with questions or concerns about the vaccine. During one-on-one virtual visits, standardized and evidence-based information was provided by a gastroenterologist or IBD nurse practitioner. Following the session, an anonymous questionnaire (NoviSurvey) evaluated key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, willingness to participate in future sessions, and recommendations for improvement. Descriptive analyses were conducted, with group means expressed as proportions for categorical variables and means for numerical variables. Results: A total of, 265 patients were invited to participate in the online survey, with a response rate of, 49% (131/265). Before the session, 48.9% (64/131) expressed COVID-19 vaccine hesitancy and, 26% (35/131) expressed concerns relating to risks versus benefits of COVID- 19 vaccines. Ninety-one percent (119/131) of respondents found the education program to be helpful and, 92% (121/131) indicated there was no information perceived to be lacking from the session. Following the intervention, the proportion of those willing to get vaccinated rose from, 61% to, 86.3%. Only, 1.5% (2/131) indicated that they would likely not get vaccinated. Most participants (77%, 101/131) found the written and virtually administered educational content to be satisfactory and, 88% (115/131) were willing to participate in similar virtual education offerings in the future. Conclusion: Implementation of an evidence-based, multidisciplinary COVID-19 vaccination education intervention delivered using a virtual platform was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed.

RAPID IMPLEMENTATION OF AN EVIDENCE-BASED, VIRTUAL COVID-19 VACCINE EDUCATION CLINIC AT NOVA SCOTIA COLLABORATIVE INFLAMMATORY DISEASE CLINIC (NSCIBD)

Background Rapid adaptation of clinical management as well as policy decisions in relation to implementation of COVID-19 vaccination programs for persons living with IBD has been required throughout the pandemic. Aims To meet the need for public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtual COVID-19 vaccine educational intervention was developed, implemented, and evaluated. Methods An observational, cross sectional, implementation-effectiveness study was conducted at the NSCIBD program between April and July, 2021. The educational intervention consisted of a standardized evidence-based letter describing risks and benefits of COVID-19 vaccine emailed to patients in advance of a virtual clinic appointment. Virtual appointments were offered to all patients contacting the NSCIBD program with questions or concerns about vaccination. During these virtual visits standardized, evidence-based information was provided by a gastroenterologist (n=2) or IBD nurse practitioners (n=2) and patients were provided with an opportunity to address specific disease and treatment related concerns. Following the session, a link to an anonymous questionnaire was distributed via email to evaluate key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, and recommendations for improvement. Data analysis was descriptive. Group means were expressed as proportions for categorical variables and means for numerical variables. Results A total of 298 patients participated in a virtual patient education session of which 265 provided a valid email address and invited to participate in the on-line survey. The response rate was 49% (131/265). Before the session, 48.9% (64/131) expressed vaccine hesitancy. Twenty-six percent (35/131) expressed concerns relating to risks versus benefits of COVID-19 vaccines. Ninety-one percent (119/131) of respondents found the education program helpful. The proportion of those willing to get vaccinated rose from 61% (pre) to 86.3% (post). Only 1.5% (2/131) indicated they would not get vaccinated. Seventy-seven percent (101/131) found the written and virtually administered educational content to be satisfactory. Eighty-eight percent (115/131) of respondents were willing to participate in similar types of virtual education offerings in the future. Conclusions Implementation of an evidence-based, multidisciplinary, virtual COVID-19 vaccination education intervention was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed. Funding Agencies None