Virtually perfect? High patient satisfaction and reduced work absenteeism using a telehealth model of inflammatory bowel disease care during the coronavirus pandemic

ABSTRACT

Background and Aims: With an emphasis now on treat to target care in inflammatory bowel disease (IBD) and a focus on strict control of inflammation, IBD management has become more dynamic, and regular monitoring is required to optimize care. This can be burdensome for patients;faceto- face clinic appointments often require absenteeism from work, which can create barriers to accessing care. In the setting of the coronavirus 2019 (COVID-19) pandemic, much of outpatient IBD care has rapidly transitioned to a telehealth model. Our aims were to (i) assess patient satisfaction with the telehealth platform for IBD appointments in the COVID-19 period;(ii) review the failure to attend clinic rates for telehealth appointments during COVID-19, compared with a similar period before COVID-19;(iii) review rates of work absenteeism among patients attending telehealth appointments during COVID-19, compared with a similar period before COVID-19;and (iv) explore patients' beliefs with respect to the safety of their immunomodulatory (IM) therapy in the COVID-19 era, whether they could be reassured by nursing or medical staff with respect to the risks of IM treatment during the COVID-19 pandemic, and their adherence to IM therapy. Methods: At a large tertiary IBD center in Melbourne, Australia, patients with IBD who had attended a scheduled IBD telehealth clinic via video link or phone call from April to June 2020 were invited, via text message, to participate in a web-based survey (ethics approval QA 20056). The 15-question survey assessed patient satisfaction, concerns, and behavior regarding their treatment and the impact of telehealth clinic appointments on patients' working schedules. The questions regarding patient satisfaction were modeled on the validated Short Assessment of Patient Satisfaction questionnaire. Results: A total of 483 patients were invited to participate in this survey, and 86 have so far completed the survey. Of these, 76 patients (92%) were either satisfied or very satisfied with the treatment they have received, 74 (88%) were satisfied or very satisfied with the health counseling they received, and 74 (88%) agreed or strongly agreed that they had a thorough assessment. There were 69 patients (84%) who were either satisfied or very satisfied with the overall care they received during their telehealth appointment. Failure-to-attend rates were similar for telehealth appointments during the COVID-19 pandemic and for standard appointments during the same period before COVID-19 (10.5% vs 11.4%). Seventeen patients (20%) needed to take time off work to attend a telehealth appointment, compared with 55 (64%) who would previously have taken time off work for a traditional face-to-face clinic appointment. We found that 47 patients (55%) were concerned that their IM therapy put them at increased risk of COVID-19 infection, but most (98%) did not make any alterations to their therapy without the advice of our IBD unit, despite their concerns. After advice received from our IBD unit, most patients (42, 69%) who were concerned about their IM use could be reassured. Conclusion: In this study, patients report high levels of satisfaction with telehealth for their IBD care during the COVID-19 pandemic. This model of care was not associated with a higher rate of clinic non-attendance. Telemedicine reduced work absenteeism when compared with traditional face-to-face clinic appointments. A significant proportion of patients with IBD had concerns about their IM use during the COVID-19 pandemic, but most could be reassured after specialist nursing or medical consultation. We would encourage health providers and payors to consider the expansion of telemedicine beyond the COVID-19 pandemic as an acceptable way of delivering clinic care, and one that is associated with reduced work absenteeism compared with traditional face-to-face outpatient models of care.