ABSTRACT
Introduction The COVID-19 pandemic has forced healthcare professionals (HCPs) to rapidly alter their delivery of outpatient services. Perceived benefits include reducing unnecessary travel and waiting times. However, as one of the geographically largest training regions in the UK, we aimed to determine satisfaction levels amongst gastroenterology HCPs with the 'new normal'. Methods Satisfaction surveys were disseminated electronically across 13 acute trusts in the South West between June and August 2021. These consisted of multiple choice questions and Likert 5-scale ranking questions, ranging from 'strongly agree' to 'strongly disagree'. Virtual clinics were defined as telephone or video consultations. Results 64 HCPs from 7 trusts responded (52% consultants;23% registrars;19% nurse specialists;6% dieticians). 80% had performed phone consultations and 23% were providing video consultations. 94% of participants stated face-to-face (F2F) consultations remained their preferred mode of clinic, whilst video consultation was the least favoured for new patients. For follow-up patients, the most favoured combination was phone and F2F consultations, followed by solely F2F consultations. Less than a third of respondents strongly agreed that they would be comfortable using a computer for video consultation (32%), compared to over half when using phone instead (53%). 47% of HCPs stated virtual clinics were now the default clinic mode in their trust. The majority of respondents found it difficult to develop a rapport with remote consultations, with only 19% respondents stating this was not an issue. There was equipoise about whether time efficiency improved with virtual consultations, though 60% of respondents agreed or strongly agreed that virtually delivered clinics can reduce clinic non-attendance. Two thirds of respondents did not have a local process to identify patients who would not benefit from virtual clinics, whilst over three quarters did not have technical support to troubleshoot issues during virtual clinics (78%). Only five respondents (8%) thought it was straightforward to include an interpreter on a virtual consultation and 70.3% had difficulties including relatives on virtual calls. Conclusions Gastroenterology departments in the South West continue to adapt to delivery of virtual clinics, through a predominantly telephone format. There is consensus that followup patients do not routinely need to F2F appointments, but new patients should primarily be seen F2F. Departments should have clear protocols to identify patients that will not benefit from virtual consultations. Finally, robust strategies are required to accommodate patients whose first language is not English to ensure they are not disproportionately disadvantaged.
ABSTRACT
Introduction The COVID-19 pandemic has forced patients to rapidly adjust to virtual consultations in outpatients. A perceived benefit is reducing unnecessary travel. However, there is a paucity of literature describing acceptability of virtual consultations to gastroenterology patients. Methods In collaboration with the Patient Experience team, satisfaction surveys were disseminated in Gastroenterology and Hepatology clinics at Bristol Royal Infirmary electronically via SurveyMonkey® and paper format between June and August 2021. These consisted of multiple choice questions and Likert 5-scale ranking questions, ranging from 'strongly agree' to 'strongly disagree'. Virtual clinics were defined as telephone or video consultations. Data was collected on patient demographic, travel method, satisfaction with virtual clinics, and preferences for service delivery. Results 100 patients completed the survey (27% aged 55- 64yrs;21% aged 65-74 years). 50%, 27% and 23% of patients were from hepatology clinic, inflammatory bowel disease clinic and general gastroenterology clinic respectively. 84% were follow-up patients. 56% of patients normally drove to appointments, with a further 30% taking public transport. 23% of patients were travelling over 10 miles to attend appointments. 38% of patients were in full-time employment of which 63.1% had to take annual leave to attend appointments (n=24/38). 82% of patients owned a laptop of which 19.5% (n=16/82) disagreed or strongly disagreed with feeling comfortable using their computer for an online appointment. Face-to-face (F2F) consultation was the preferred mode of appointments in almost half of patients (49%), followed by a mix of F2F and telephone consultations (19%). 54% of patients agreed or strongly agreed that clinicians could address their concerns virtually, with only 16% disagreeing or strongly disagreeing with this. 65% of patients agreed or strongly agreed they felt comfortable sharing personal information during a virtual consultation, with 14% of patients disagreeing or strongly disagreeing with this. 80% of patients stated they would want to receive bad news in a F2F consultations. Conclusions Virtual consultations appear to be acceptable rather than preferable to gastroenterology patients. F2F consultations remain the overall preference, particularly when receiving bad news. Virtual consultations can provide flexibility in service delivery. This is important given almost two thirds of patients in full time employment had to take annual leave to attend an appointment. Furthermore, as services consider their carbon footprint, with half of patients driving to their appointments in Bristol, virtual consultations offer a genuine opportunity to provide a greener service.
ABSTRACT
Background During the first wave of the coronavirus (COVID-19) pandemic, restrictive public health measures including prolonged shielding, were recommended by the United Kingdom government for many patients with immune-mediated inflammatory disorders treated with immunosuppressive and biologic drugs. Low-volume intracapillary blood sampling can be undertaken by patients at home and returned by post and may ensure access to therapeutic drug monitoring (TDM) for all patients irrespective of shielding status. Methods We undertook a cross-sectional blood sampling methods comparison study to assess the clinical validity and acceptability to patients of low volume intracapillary testing for serum TDM enzyme-linked immunosorbent assays (ELISA) compared to conventional venepuncture. Sample types were compared using linear regression and fit-for-purpose equivalence was defined using total allowable error (TEa) rates derived using interassay coefficient of variations from routine clinical practice. Acceptability was assessed using a purpose-designed questionnaire. Results The median (IQR) volume of serum obtained using intracapillary sampling was 195μL (130 - 210). We showed drug level equivalence (slope [95% CI]: TEa vs observed mean % difference) between intracapillary sampling and conventional venepuncture for adalimumab (1.02 [0.90 - 1.14]: 11.7% vs 2.1%) (Figure 1), infliximab (1.08 [0.98 - 1.18]: 18.3% vs 1.2%), vedolizumab (0.91 [0.85 - 0.96]: 17.6% vs 4.1%), and ustekinumab (0.92 [0.90 - 0.94]: 19.4% vs 3.3%). Anti-drug antibody equivalence was observed for antiadalimumab (0.96 [0.95 - 0.98]: 24.5% vs 2.1%) and anti-infliximab (0.89 [0.81 - 0.97]: 17.3% vs 1.3%) antibody levels. Most patients reported that intracapillary testing was easy, convenient, and that they preferred it to conventional venepuncture (Figure 2). Conclusions Low-volume intracapillary blood sampling was equivalent to conventional venepuncture for the measurement of biologic drug and anti-drug antibodies. Patients preferred intra-capillary testing to conventional venepuncture. Irrespective of future COVID-19 surges, patient-led intracapillary blood sampling is likely to become a key adjunct to telemedicine in patients with immune-mediated inflammatory diseases.(Figure Presented) Adalimumab drug Linear regression and Bland Altman plot Left: Linear regression analysis of venous vs capillary adalimumab drug level results (mg/L), Slope 1.02 [0.90 - 1.14]. Right: Bland Altman plot of mean of venous and capillary adalimumab drug measurement against percentage difference between TEa vs observed mean % difference.(Figure Presented) Figure 2: Questionnaire acceptability response data Patient acceptability questionnaire response results by 5-point Likert scale. (A) Itemised proportional responses, grouped by domain. (B) Cumulative agreement per respondent;+1/+2 points for agree/strongly agree, 0 for neither agree nor disagree, -1/-2 for disagree/strongly disagree. Lowest decile reflecting participants with lowest acceptability scores indicated.
ABSTRACT
Introduction: Adolescence is a transitional life-stage accompanied by large biopsychosocial changes and greater psychophysiological vulnerability. Global events like the COVID-19 pandemic may increase vulnerability to depression and anxiety in this population. Poor sleep is often associated with depression, and both sleep and mood have been shown to be strongly impacted by the COVID-19 pandemic, with most studies focusing on adults. The current study investigates psychological distress in young adolescents during the pandemic, and specifically, whether poor sleep before the pandemic predicts psychological distress. Methods: Self-report data were analyzed from 3099 adolescents (9-10 years at baseline) in the population-based, demographically diverse, Adolescent Brain Cognitive Development (ABCD) study across three pre-pandemic annual visits and 3 monthly time points during the COVID-19 pandemic (ages 11-13 years). At each assessment, children and their guardians completed questionnaires including those about sleep, environment, and psychological wellbeing. Gradient Boosted Tree machine learning algorithms were used to identify the strongest predictors of pandemic-related psychological distress in individuals. We trained models using pre-pandemic sleep measures along with demographics, economic, and social measures during the pandemic. We evaluated the performance of the models using area under curve (AUC) metrics and interpreted the models by using the recently proposed SHapley Additive exPlanations methodology. Results: Pandemic-related perceived stress, fear and sadness were accurately detected with our classifiers (AUC = 0.83 for perceived stress, AUC = 0.73 for fear, AUC = 0.79 for sadness). Across all models, shorter sleep duration, prolonged sleep onset latency, and longer time between waking and getting out of bed predicted greater distress. Moreover, female sex, and pandemic-related factors, including greater family conflict, fewer economic resources, and more screen time contributed to prediction performance in all three models. Conclusion: Findings highlight the importance of addressing sleep problems and ensuring sufficient sleep duration in children to protect against the psychological impact of major life events, including the COVID-19 pandemic. Considering the long-lasting effects of sleep, it would be crucial to improve sleep health by targeted prevention, intervention and increased awareness among adolescents.