ABSTRACT
Background: In August 2016 Cortiment® was approved for use in ulcerative colitis (UC) patients in Canada, but not approved for reimbursement;the Canadian Agency for Drugs and Technology in Health cited no comparable benefit for its use over other approved UC medications. Real-world data comparing Cortiment® to other UC medications is limited, especially during the COVID-19 pandemic where the use of steroids is counter-indicated for COVID-19-related outcomes. Aims: To examine the comparative risk of hospitalization, surgery, and infection after initiation of Cortiment® or oral corticosteroids among UC patients using real-world data Methods: Using population-based data from Alberta Canada, two cohorts were compared: 1. Patients dispensed Cortiment® and an ICD diagnostic code for UC [9: 556.X;10: K51.X] (August 1, 2016 to October 31, 2019);and, 2. Validated (algorithm) UC patients dispensed a >30 day supply or >500mg in 24 hours of prednisone/prednisolone (April 1, 2016 to October 31, 2019). All hospitalizations, IBD-surgery, or infections (i.e., pneumonia, c.diff, sepsis, tuberculosis) that occurred 6 or 12 months from initial medication dispensing were identified. Cox-proportional hazard models, with Hazard Ratios (HR), assessed comparative outcomes. Kaplan-Meier survival curves were created, and Poisson regression (or negative binomial) used to assess the Average Monthly Percentage Change (AMPC) with associated 95% confidence intervals (CI). Results: We identified 917 Cortiment® and 2,404 Prednisone patients. Over the study period, prednisone dispensing significantly decreased (AMPC:-2.53% [CI:-2.85,-2.21]) while Cortiment® remained stable. Dispensing of Cortiment® significantly decreased the hazard of hospitalization (all types, except surgery) at 12 months as compared to prednisone, and significantly decreased the hazard of an infection at both 6 and 12 months (Table 1, Fig 1). Conclusions: The use of Cortiment® in a real-world setting is associated with fewer deleterious outcomes, and its use during a pandemic should be preferred, especially when it's counterpart can exacerbate negative COVID-19-related outcomes. (Table Presented).
ABSTRACT
Background: In light of the COVID-19 pandemic, gastroenterologists in Alberta moved to virtual care for many clinic visits. As the public health situation evolves, it is important to evaluate provider satisfaction with virtual care during these unprecedented times. Aims: To assess healthcare provider (HCP) satisfaction with virtual care during the COVID-19 pandemic. Methods: We administered a 20-item satisfaction survey that assessed the usefulness, ease of use, interface qualities, reliability, and overall satisfaction with virtual care tools for the delivery of care to patients with gastrointestinal diseases. One hundred and twenty-five gastroenterologists in Alberta were invited to participate via email. We used a modified Telehealth Usability Questionnaire (TUQ) which was open for response from June 19-August 30, 2020. Results: The overall response rate was 19% (24/125) with 46% female respondents. Most respondents worked in an academic facility (63%) and had been in practice for a mean duration of 12.3 years. Respondents were from seven facilities within the South, Calgary, Central and Edmonton health zones. Virtual care reported was a hybrid model consisting of telephone and in-person (54%) or telephone and video consults (42%). Although 90% indicated that virtual care tools improved access to healthcare, provided location flexibility and were appropriate to meet healthcare needs, only 42% agreed that it saved time. Inconclusive virtual consultations due to the absence of physical examination and missing lab values was reported by 75% and 33% of HCPs, respectively. Ninety-five percent of HCPs who used video conferencing found it simple, easy to learn and were able to become productive quickly with it. Over 60% of HCPs reported that virtual care (irrespective of the platform used) was not the same as in-person visits. The mean overall satisfaction for HCPs who rarely or never had virtual care prior to the pandemic, was 0.57 points higher than those who often provided virtual care (4.36 vs 3.79;95% CI: 0.26-0.88, p=0.001). Overall, 88% of providers were satisfied with virtual care and all respondents were willing to use it again (Figure 1). Identified areas of concern included patient safety, patient education on best practices, adequate remuneration, additional administrative duties, and challenges with providing care for new patients on virtual platforms. Conclusions: This survey of GI providers in Alberta showed high satisfaction and acceptance with virtual care. However, the majority reported it to be less reliable than in-person visits. Access to Alberta Netcare to view investigations was deemed valuable. Areas of concern that needs to be addressed include patient education on virtual care best practices and provider resources to assist with new consultations on virtual platforms.
ABSTRACT
Background: The COVID-19 pandemic is affecting patients and healthcare providers worldwide. During the first wave of the pandemic, healthcare delivery shifted from in-person to virtual clinics. Non-urgent and some emergent procedures, including endoscopies, surgeries, and imaging, were delayed to limit the spread and divert resources to COVID-19. Aims: To assess the impact of the COVID-19 pandemic in care to IBD patients Methods: A survey study was conducted to assess the impact of the COVID-19 pandemic on IBD care. All patients had a virtual clinic appointment between March to July 2020 at either: University of Alberta Hospital or the University of Calgary Clinic. A section of the survey assessed patient experience of virtual clinics and delays in access to IBD care during the COVID-19 pandemic. Results: A total of 1581 patients were contacted to complete the survey. 628 patients agreed to participate in the survey, however not all patients completed each component. The mean age of patients who participated in the survey was 48 years (SD = 15.19). 408 patients responded to satisfaction/future use questions: 84.3% (344) patients agree/strongly agree they were comfortable communicating to the physician using the remote system, 77.5% (316) of patients agree/strongly agree that virtual clinic is an acceptable way to receive healthcare services, 84.8% (346) of patients agree/strongly agree they would use virtual care services again, and 82.6% (337) agree/strongly agree they were satisfied with the telehealth system. Additional challenges were reported by 228 patients. Fear and stress (infection risk/mental health concerns/unemployment) was reported by 57.4% (131) patients. Access to healthcare services, PPE, and community resources was a challenge experienced by 26.3% (60) patients. Additionally, 16.2% (37) patients experienced uncertainty around IBD-specific care, including procedures, treatments, labs, and medications. Overall, 17.3% of patients reported some type of delay in care by July 2020. Table 1 shows the proportion of patients with a delay by type of care and the median delay: 5.7% of patients with IBD had surgery delayed by a median of 10 weeks (8-16 weeks). Conclusions: While some delays in healthcare delivery occurred during the first wave of the pandemic, overall 82.7% of patients with IBD maintained their care without disruption. Sustaining healthcare delivery to the IBD community required adaptation to virtual care;however, patient satisfaction was overwhelming positive among patients with IBD.
ABSTRACT
BACKGROUND The COVID-19 pandemic is affecting patients and healthcare providersworldwide. During the first wave of the pandemic, healthcare delivery shifted from inpersonto virtual clinics. Non-urgent and some emergent procedures, including endoscopies,surgeries, and imaging, were delayed to limit the spread and divert resources to COVID-19. AIMS To assess the impact of the COVID-19 pandemic in care to IBD patients METHODSA survey study was conducted to assess the impact of the COVID-19 pandemic on IBDcare. All patients had a virtual clinic appointment between March to July 2020 at either:University of Alberta Hospital or the University of Calgary Clinic. A section of the surveyassessed patient experience of virtual clinics and delays in access to IBD care during theCOVID-19 pandemic. RESULTS A total of 1581 patients were contacted to complete thesurvey. 628 patients agreed to participate in the survey, however not all patients completedeach component. 423 patients reported which hospital they receive their care: 71.2% (301)were from the University of Alberta, 24.6% (104) were from the University of Calgary, and2.9% (18) did not list either hospital. 429 patients provided a postal code, where 71.8%(308) were from either the Calgary or Edmonton metropolitan area. The mean age of patientswho participated in the survey was 48 years (SD = 15.19). 408 patients responded tosatisfaction/future use questions: 84.3% (344) patients agree/strongly agree they were comfortablecommunicating to the physician using the remote system, 77.5% (316) of patientsagree/strongly agree that virtual clinic is an acceptable way to receive healthcare services,84.8% (346) of patients agree/strongly agree they would use virtual care services again, and82.6% (337) agree/strongly agree they were satisfied with the telehealth system. Table 1shows additional challenges experienced by patients. Overall, 17.3% of patients reportedsome type of delay in care by July 2020. Table 2 shows the proportion of patients with adelay by type of care and the median delay: 5.7% of patients with IBD had surgery delayedby a median of 10 weeks (8-16 weeks). Of note, 73.9% (51) of patients were from theUniversity of Alberta, 23.2 (16) were from the University of Calgary, and 2.9% (2) patientsdid not associate with either hospital. Additionally, 75.4% (52) of patients who experienceddelays live within the Calgary/Edmonton metropolitan area. CONCLUSION: While somedelays in healthcare delivery occurred during the first wave of the pandemic, overall 82.7%of patients with IBD maintained their care without disruption. Sustaining healthcare deliveryto the IBD community required adaptation to virtual care;however, patient satisfaction wasoverwhelming positive among patients with IBD.(Table Presented)Table 1: Additional Challenges Experienced by Patients (N = 228)(Table Presented)Table 2: Proportion of IBD Patients with delays in care (N=398)