ABSTRACT
Background: During the COVID-19 pandemic, patients experienced significant care disruptions, including lab monitoring. We investigated changes in the time between viral load (VL) checks for people with HIV associated with the pandemic. Methods: This was an observational analysis of VLs of people with HIV in routine care at a large subspecialty clinic. At pandemic onset, the clinic temporarily closed its onsite laboratory. The exposure was time period (time-varying): pre-pandemic (January 1st 2019-March 15th, 2020);pandemic lab-closed (March 16th-July 12th, 2020);and pandemic lab-open (July 13th-December 31st, 2020). We estimated time from an index VL to a subsequent VL, stratified by whether the index VL was suppressed (<= 200 copies/mL). We also calculated cumulative incidence of a non-suppressed VL following a suppressed index VL, and of re-suppression following a loss of viral suppression. Results: Compared to pre-pandemic, hazard ratios for next VL check were: 0.34 (95% CI: 0.30, 0.37, lab-closed) and 0.73 (CI: 0.68, 0.78, lab-open) for suppressed patients;0.56 (CI: 0.42, 0.79, lab-closed) and 0.92 (95% CI: 0.76, 1.10, lab-open) for non-suppressed patients. The 12-month cumulative incidence of loss of suppression was the same in the pandemic lab-open (4%) and pre-pandemic period (4%). The hazard of re-suppression following loss of suppression was lower during the pandemic lab-open versus the pre-pandemic period (hazard ratio: 0.68, 95% CI: 0.50, 0.92). Conclusions: Early pandemic restrictions and lab closure significantly delayed VL monitoring. Once the lab re-opened, non-suppressed patients resumed normal monitoring. Suppressed patients still had a delay, but no significant loss of suppression.
ABSTRACT
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.
ABSTRACT
Background/Introduction: Cardiaovascular prevention/rehabilitation programmes continue to reduce cardiovascular mortality even with contemporary treatment. During covid the majority of face-to-face programmes were suspended but these services have never been more crucial as control of cardiovascular risk factors can mitigate the morbidity/mortality risk from covid. Programmes must now however be delivered in a way that reduces patient exposure. Here we describe how we rapidly transitioned our previously fully face to face cardiovascular prevention/programme to a completely virtual platform adopting Fitbit as wearable technology. Methods: The previously face-to-face initial assessment (IA) conducted by the multidisciplinary team (MDT) - nurse, dietician and physiotherapist is now delivered via video/phone as per patient preference. Patients are provided with equipment kits (tape measures, blood pressure monitors (BP), Fitbit smartwatches and Fibricheck app as required. The virtual IA includes assessment of: Smoking habit, blood pressure (BP), heart rate, lipid profile and HbA1c (taken in community phlebotomy hub), cardioprotective medications, weight, BMI, waist circumference, Mediterranean Diet Score, functional capacity via the Duke Activity Status Index, habitual activity levels, risk stratification for exercise, hospital anxiety and depression scores (HADS) and quality of life (QOL). Patients receive education and tailored advice with SMART goals as well as a written care plan. The subsequent 12 programme is comprised of • Weekly virtual meeting with cardiologist to optimise BP/lipids and medications • Alternate weekly virtual coaching consultation by MDT for monitoring/ goal resetting • Alternate weekly video group education sessions on key cardiovascular health topics • Online educational videos filmed by the MDT Monitoring of physical activity (step count, active minutes) in real time via Fibit dashboard with personalised messages sent to patients via the Fitbit app • Provision of Fibricheck app via Fibit for rhythm assessment • End of programme (EOP) assessments are then also conducted virtually Results: Between April and November 2020 n=262 had a virtual IA (94% of those offered and n=114 (95% of those offered) attended an end of programme assessment. 64% were male and the mean age was 64.1 years. Acceptance of the Fitbit device was 72% of those offered. Table 1 below shows the main clinical and patient-reported outcomes in those attending both an IA and EOP with the data for the same 6 months the year prior (face to face programme) also for comparison. Programme satisfaction ratings were high with 85% rating the programme as excellent or very good. Conclusions: Transitioning a previously fully face to face cardiac rehabilitation programme to a wholly virtual platform was feasible and acceptable to patients. Early data analysis would suggest that the virtual programme achieves similar clinical and patient reported outcomes. (Figure Presented).