Impact of COVID‐19 pandemic on the daily management of biotechnological therapy in inflammatory bowel disease patients: Reorganisational response in a high‐volume Italian inflammatory bowel disease centre

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is having a major clinical as well as organisational impact on the national health-care system in Italy, particularly in high-volume hospitals which are usually active for many essential clinical needs, including inflammatory bowel disease (IBD). Here, we report major clinical and organisational challenges at a high-volume Italian IBD centre one month after the start of the Italian government’s restrictions due to the COVID-19 pandemic. All routine follow-up IBD visits of patients in remission were cancelled or rescheduled for 8–12 weeks’ time. However, access to the hospital for therapy or for unstable/relapsing patients was not considered postponable. Everyone attending the centre (e.g. physicians, nurses, administrative personnel and patients) were advised to respect the general recommended rules for hand hygiene and social distancing, to disclose if they had a fever or cough or flu-like symptoms and to wear a surgical mask and gloves. At the entrance of the therapy area, a control station was set up in order to double-check all patients with a clinical interview and conduct thermal scanning. A total of 1451 IBD patients under biotechnological or experimental therapy actively followed in the CEMAD IBD centre were included in the study. About 65% of patients maintained their appointment schedules without major problems, while in 20% of cases planned infusions were delayed because of the patient’s decision or practical issues. About 10% of patients receiving subcutaneous therapy were allowed to collect their medicine without a follow-up visit. Finally, 10% of patients living outside the Lazio region requested access to their therapy at a local centre closer to their home. At present, five patients have been found to be positive for SARS-CoV-2 infection but with minimal symptoms, 22 are in ‘quarantine’ for contact considered to be ‘at risk’ for the infection. Up to now, none of them has experienced significant symptoms. This study represents the first observational detailed report about short-term impact of the COVID-19 pandemic on patient organisation and management in a high-volume IBD centre.

Covid-19 and the management of patients with inflammatory bowel disease: a practical decalogue for the post-pandemic phase

“…Similarly to what happened during the lockdown period, accompanying persons should not be allowed access to the infusion clinic and the number of staff (doctor and nurse) should be limited to the minimum necessary. 8 …”

“…As expected, during the pandemic, most of the elective clinical activities were suspended and the medical services really provided have reduced dramatically. 8 Outpatient visits, colonoscopies and non-urgent surgery have been postponed, as recommended by the most qualified international societies and organizations with an interest in IBD, with the aim of avoiding patient contact with the hospital environment and allowing patients with IBD to maintain rigorous isolation and reduce the risk of contagion. 8 – 11…”

The impact of a dedicated contact centre on the clinical outcome of patients with inflammatory bowel disease during the COVID-19 outbreak

“…Alternative sources of care, including remote monitoring, virtual follow up, and helplines have been included in daily practise to facilitate communication, prevent loss of follow up visits and educate patients on preventive measures. [14][15][16] To maintain high quality care for IBD patients during the COVID-19 outbreak, our helpline service, managed by the medical IBD team has proved to be a reliable tool for reorganising IBD activity in a short time by converting most physical follow-up visits to virtual follow ups. The centre also provides education resources by inviting patients to explore the websites of the national IBD society (IG-IBD) and the National Patients' Association (AMICI) in order to promote patient empowerment and encourage treatment adherence.…”

“…Alternative sources of care, including remote monitoring, virtual follow up, and helplines have been included in daily practise to facilitate communication, prevent loss of follow up visits and educate patients on preventive measures. 14 – 16 …”

Inflammatory Bowel Disease Patients With Coronavirus Disease 2019: The Picture Is Taking Shape

“…3 , 4 The major preventive measures consisted of social distancing, hand washing, the use of personal protective equipment as recommended by the health authorities, and the creation of specific dedicated paths for patients who needed to access the hospital for the administration of biological infusion therapies. 5 Obviously, similar preventive measures have been ensured for the health personnel involved in the management of these patients. Furthermore, all unnecessary visits were replaced with telemedicine.…”