P1583 - A Qualitative Analysis of the Impact of COVID-19 on IBD Management Among Vulnerable Patient Populations

Florence-Damilola Odufalu, MD¹, Uma Mahadevan, MD², Justin Sewell, MD, PhD, MPH^3
1University of California San Francisco Center for Colitis and Crohn’s Disease, Los Angeles, CA; ²University of California San Francisco Center for Colitis and Crohn’s Disease, San Francisco, CA; ³University of California San Francisco, San Francisco, CA

Introduction: Since the onset of the COVID-19 pandemic, three surges in California resulted in severe case outbreaks and fatalities. In this unprecedented time, there were rapid changes in healthcare delivery as remote access became the norm. The aim of this study was to understand the IBD patient experience with the changes in healthcare delivery during the COVID-19 pandemic, particularly those who are members of vulnerable populations.

Methods: Patients with established primary IBD at the Colitis and Crohn’s Disease Center at University of California San Francisco (UCSF) or the Gastroenterology Division at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), were identified for study inclusion. A standardized questionnaire invited patients to provide their perspective on how the changes in health delivery and economic/financial stability impacted their IBD management and disease control. Participants were invited to participate in a qualitative interview. From October 2020 to December 2020, in-depth, semi-structured interviews were conducted and analyzed using qualitative techniques.

Results: A total of 178 surveys were completed and examined experience of care and patient perceptions about COVID-19 related to IBD (Figure 1). In addition, 21 participants (8 at UCSF and 13 at ZSFG) completed interviews, yielding 8.03 hours of interviews and 217 pages of transcript. Analysis revealed 7 primary themes mechanisms by which the COVID-19 pandemic impacted IBD care: age, language, medication use, lockdown, stress, technology, and access (Table 1). Patients who did not speak English were more likely to report difficulties using technology software with telehealth visits and contacting their IBD providers with updates in symptoms.

Discussion: In this qualitative study of IBD patients, among vulnerable patient groups, barriers of language discordance, technology aversion, age and financial/emotional stress contributed to perceptions of worsened care and IBD activity during the COVID-19 pandemic. This study highlights that in IBD, vulnerable patient groups particularly those with lower socioeconomic status and language discordance from their providers, may face more challenges with changes to healthcare delivery and have difficulty in access to care and conveying changes in IBD activity.


Figure: Figure 1. Questionnaire Results by Language

Theme	Excerpts
Age	“Face-to-face. Maybe I'm an old-fashioned person of course. It's my age, but I like the idea of seeing my healthcare providers at a personal level.” - COVIDIBD34
Language	“I cannot properly explain what is it that I feel …when I do get the colics, or the cramps, I cannot show him specifically where it is and show him how it hurts and really explain how it is.” - COVIDIBD22
Medication	“… but at that point, COVID was already happening and I was afraid to go on a biologic medicine because I was worried it was going to lower my immune system. I was scared to try anything or to put myself in any further risk. So, I didn't really follow through.” - COVIDIBD1
Shutdown/Lockdown	“I was actually dealing with a flare at the time [February]. I was in the hospital for three days, and went home, and it spiraled much worse, and was back in the hospital in March for 11 days. And it was interesting in the hospital, because it was almost like we were trying to get me out of the hospital as fast as possible, because they were preparing the hospital for COVID. And I was also very, very scared to be in the hospital because of COVID.” - COVIDIBD36
Stress	“I feel nervous even now going in for all of my checkups for my pregnancy...especially since I was getting so many colonoscopies so frequently and needing to get so much blood work... affected me a lot in terms of my treatment.”- COVIDIBD35
Financial Hardship	“Well, it hasn't been. Like paying the rent and things like that. Sometimes it gets a little hard to even buy food. There's a lot of stress. I have my daughter in Guatemala that I need to care for, my father is getting really old and I need to care for him, and it's been causing a lot of stress.”- COVIDIBD25
Technology	“Well, I guess like MyChart, I did try to sign up a couple of times and it was just kind of a cumbersome way to do it. So, I just kind of just gave up and never did it.”- COVIDIBD38
Access	“I think it was slightly worse just because it was slower getting to see a doctor and get the medications to me due to the restrictions that needed to be in place.”- COVIDIBD25

Table: COVID-19 impact concepts and supporting excerpts


Disclosures:
Florence-Damilola Odufalu indicated no relevant financial relationships.
Uma Mahadevan: AbbVie – Consultant. Janssen – Consultant. Pfizer – Consultant. Takeda – Consultant.
Justin Sewell indicated no relevant financial relationships.


Florence-Damilola Odufalu, MD¹, Uma Mahadevan, MD², Justin Sewell, MD, PhD, MPH³. P1583 - A Qualitative Analysis of the Impact of COVID-19 on IBD Management Among Vulnerable Patient Populations, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.