ABSTRACT
Introduction: The COVID-19 pandemic prompted a rapid shift to telehealth for care delivery. We aimed to assess satisfaction with and preferences for telehealth to improve care experiences for patients with irritable bowel syndrome (IBS). Methods: We conducted a prospective survey-based cross-sectional study from September 29 to November 9, 2020 in a diverse, community-based integrated healthcare system in Southern California. We included members age 18-90 with an International Classification of Diseases 9, 10 code for IBS from an office-based encounter between June 1, 2018 to June 1, 2020. A specifically developed survey (TIBS-CoV2) was emailed to patients. We collected demographic and clinical data from the electronic medical record. We assessed satisfaction via 5-point Likert scale (“strongly agree and agree” was defined as satisfied;“strongly disagree and disagree” as dissatisfied). Using Chi-square and Wilcoxon Rank Sum tests, we compared demographic and clinical characteristics of those who were satisfied and dissatisfied with telehealth in patients with ROME IV IBS. We used multivariate logistic regression to identify predictors for telehealth satisfaction. Results: Of 44,789 surveys sent, 2598 (5.8%) patients responded, 1473 (56.7%) completed the entire survey (median age 60.0 [42.4-71.2], 80.1% female;66.3% non-Hispanic white, 22.1% Hispanic, 5.0% black, 4.0% Asian) and 744 (28.6%) had ROME IV confirmed IBS. 651 (87.5%) patients with IBS used telehealth for their care: 436 (67.0%) were satisfied, 62 (9.5%) were dissatisfied and 153 (23.5%) felt neutral about their experience. No significant differences were seen in sex, race/ethnicity, BMI, marital status, income, IBS subtype or severity between satisfied and dissatisfied groups (Table 1). Telehealth satisfaction was associated with full-time employment (188, 43.1%, p>0.001), a college degree or higher (244, 56.0%, p=0.01), or daily social media use (338, 77.5%, p=0.01). Dissatisfaction was associated with older age (59.2±17, p<0.01), retirement (26, 41.9%, p=0.02) and low self-perceived health literacy (4, 6.5%, p=0.008). Satisfied patients would consider telehealth over a face-to-face visit for a travel time of 30-59 minutes (170, 39.0%, p=0.01);dissatisfied patients did not consider travel time a factor (23, 37.1%, p>0.001). Multivariate analysis confirmed age, a college degree, daily use of social media and travel time of 30-59 minutes as independent predictors of telehealth satisfaction (Table 2). Conclusions: A majority of patients with IBS are satisfied with telehealth and are more likely to use telehealth since the COVID-19 pandemic. Factors including age, available time, education level, health literacy and comfort with technology likely influence satisfaction with telehealth in IBS and may help to identify patients who would be most responsive to a focused IBS-telehealth program.(Table presented) (Table presented)
ABSTRACT
Background and Objective: With the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, various aspects of health care have been affected;however, there has been an unknown effect on hospital admissions for gastrointestinal (GI) diseases and the potential consequences on specific illnesses. Our study aims to characterize the rates of GI disease hospitalizations during the pandemic as compared to prior and any differences between specific gastrointestinal diseases throughout this period. This will be important in highlighting any gaps of care as related to gastroenterology during COVID-19.Methods: We conducted a retrospective, cross-sectional study between the months of January to May from the years 2016-2020 in a regional integrated health care system. January –May 2020 was delineated as the COVID-19 period. ICD-10 codes were used to identify principal diagnoses related to the most common GI hospitalizations in the United States (upper GI hemorrhage, pancreatitis, liver disease, diverticular disease, cholelithiasis). Rates of hospitalization were then calculated per 100,000 members for each calendar month and each respective year. Rates for the 5 most identified GI diseases were then calculated using a similar method from 2019 as compared to 2020. The rate of percent change for each month for these diseases were then analyzed during the pandemic year of 2020 versus the preceding year of 2019.Results: A total of 4589 (rate of 19.57 per 100,000) hospitalizations for GI related diseases occurred between January – May 2020 as opposed to 5328 (rate of 23.10 per 100,000) hospitalizations from January – May 2019 (p=0.03). The median age in 2020 was 59.1 (p= 0.27 compared to 2019) with a 51% female to male ratio. 38% of patients were White, 42% Hispanic, 10% Black, 8% Asian (p=0.58 compared to 2019 for all ethnicities). There was a decrease in the rate of hospitalization in each month from January – April 2020 compared to 2019 with a subsequent rise in May. There was a 2.86 increase in rate of hospitalization (p<0.01) from April to May 2020. There were only significant differences (p<0.05) in hospitalization rates between the months of March – May from 2020 versus 2019. Of the 5 most common GI diseases, upper gastrointestinal hemorrhage showed the highest average rate change of -20% from 2020 to 2019. Cholelithiasis had a change of -15%, pancreatitis with a change of -14%, diverticular disease with a change of -11%, and liver disease with a change of -9%.Conclusion: GI related hospitalizations decreased during the COVID-19 pandemic as com-pared to the previous year. Upper gastrointestinal hemorrhage showed the most average rate change of the GI diseases. Further studies highlighting the implications of these findings, such as mortality and severity of illness during the pandemic, need to be completed to assess the impact COVID-19 on GI disease.(Figure presented)(Table Presented)
ABSTRACT
Background: Southern California Kaiser cares for 4.7 million patients of which thousands carry a diagnosis of Inflammatory Bowel Disease (IBD). As the SARS-COV2 Virus has rapidly become a worldwide pandemic that causes the deadly COVID-19 respiratory syndrome, particular attention has been paid to patients with chronic IBD, who often take immunosuppressive medications that pose greater infectious risk than those in the general population. Although recent international studies have not shown worsening outcomes among IBD patients with COVID 19, not much is known about the local, regional characteristics of this population. In this study, we aim to describe the characteristics of IBD patients in the Southern California Kaiser healthcare system who have been diagnosed with COVID-19. Methods: We retrospectively gathered data from the electronic medical records of adult IBD patients who carry an ICD-10 diagnosis of Ulcerative colitis (UC) or Crohns disease (CD) and who were also diagnosed with COVID-19 with a positive lab result and ICD 10 code between the dates of January 1, 2020 and October 31, 2020. We then tabulated descriptive data among non-hospitalized, hospitalized, and deceased patients of this population. This data was verified through manual chart review. Results: Among 13,262 patients with IBD, 475 cases with suspected COVID were obtained and 280 patients had a confirmed positive COVID-19 test on manual review (89 CD, 191 UC). Average age was 49 years old with a female predominance of 59%. 14%(n=39) of patients were hospitalized and 2.5% (n=7) died. The population was predominantly White (48%) and Hispanic (37.5%). 36% of patients were not on any IBD medications while 38.9% were on aminosalicylates, 21% were on biologic agents, 9.3% were on thiopurines, and 4.3% were on corticosteroids. Among the hospitalized patients, 67%(n=26) were admitted for COVID-19. Hospitalized patients had an average age of 61 years old, 51% were female, and had an average length of stay of 7.7 days. 56.4% (n=22) were not on any IBD medications, while 7.7% (n=3) were on corticosteroids, and 18% (n=7) were on biologic agents. Among patients that died, 71%(n=5) died of COVID-19 related complications and 14% (n=1) died of renal failure. None were on biologic agents and 71% (n=5) were not on any medications for IBD. Conclusion: This study did not show increased risk of mortality among patients with IBD who are on biologic therapy. Mortality rate is comparable to published data in patients without IBD. Overall, the diagnosis of COVID 19 was associated with patients that were predominantly women, White or Hispanic, and patients not on any medications for IBD. Further research will be conducted to analyze risk factors such as medical co-morbidities in this population. (Table Presented) (Table Presented) (Table Presented)
ABSTRACT
Background: New-onset hyperglycemia may suggest presence of occult pancreatic cancer. The aim of this pilot study was to assess feasibility of pancreatic imaging in patients enrolled in the prospective NOD cohort study. Methods:We conducted a prospective pilot study November 2018-April 2020 within Kaiser Permanente Southern California. Patients 50-85 years enrolled in the NOD study (newly elevated glycemic parameter, no history of diabetes) were invited to complete a three-phase contrast-enhanced computed tomography pancreas-protocol scan. Time to imaging, abnormal pancreatic findings, incidental extra-pancreatic findings, including those prompting additional clinical evaluation were identified. Variability in clinical reporting (descriptors of pancreatic duct and parenchyma) between medical centers was assessed. Results: The majority (88.4%, N = 130) of 147 patients invited consented to undergo imaging;91 scans were completed (prior to COVID-19 stay-at-home orders). Median time from radiology order to imaging was 19.7 days (IQR, 15.4-27.6). Median age was 60.8 years (IQR, 56.3-68.8), 37.8% female;race/ethnicity was Hispanic (41.1%), followed by non-Hispanic white (27.8%), blacks (13.3%), and Asians (13.3%). One (1.1%) case of pancreatic cancer was detected between enrollment and study imaging;12/91 (13.1%) of patients had other pancreatic findings: 2 atrophy, 5 fatty infiltration, 1 divisum, 3 cysts, 1 calcification. Among those with findings, 2 (16.7%) underwent further diagnostic evaluation. Therewere 57 extra-pancreatic findings among 52 (57.1%) unique patients, of which 21.1% (12/57) prompted clinical evaluation. Reports from one of the 8 participating medical centers more frequently described both normal pancreatic parenchyma and normal ducts (39/42 (92.9%) compared to 9/49 (18.4%), P < 0.0001). Conclusions: Among participants in this pilot NOD study, pancreatic imaging was found to be acceptable and feasible to be completed in a timely fashion. There was a high rate of incidental findings as well as significant variability in clinical reports. These challenges will need to be addressed in future studies evaluating early detection of pancreatic cancer.