Conversion to a phone clinic for the management of inflammatory bowel disease in the COVID-19 era

Background: The coronavirus disease 2019 (COVID-19) pandemic has necessitated a shift in traditional models of medical care, with the well-worn path of multidisciplinary teams providing face-to-face consultation no longer being acceptable This is especially important for patients with inflammatory bowel disease (IBD), given the initial concern of increased risk of severe COVID-19 secondary to systemic immunosuppression Decisions regarding new care delivery needed to be made swiftly, with implementation within days, creating opportunities for error Methods: From March 23, 2020, all IBD clinics at the Sunshine Coast University Hospital were converted to phone clinics Patients were contacted by text message 1 week beforehand to notify them of the change and remind them of the ongoing need for pathology results to be collected before their appointment Patients were given a time frame of 2 h within which to expect their consultation phone call A clinical nurse-led IBD Helpline was available during business hours to answer patient questions Surveillance endoscopic procedures and intestinal ultrasounds were canceled for about 2 months at the start of the local pandemic, but emergency endoscopic procedures were continued throughout Results: Between March 23 and June 30, 2020, a total of 440 patients had a scheduled review: 78% had a single review, 20% had two consultations, and 2% had more than two consultations Overall, 86% of patients answered the phone in the allocated time frame Of the patients, 65% had completed the pre-appointment blood pathology tests and 49% hadcalprotectin testing A phone consultation was deemed insufficient to provide adequate care to 17 patients (3%), who then attended a face-to-face consultation Clinical activity scores were recorded for 305 patients, of whom 86% were in clinical remission (as defined by a partial Mayo score < 2, Harvey-Bradshaw Index < 5, Crohn's Disease Activity Index < 150) No emergency admissions or unplanned surgeries occurred in this period Conclusion: This early analysis of a COVID-19 IBD phone clinic found that the majority of patients were able to be adequately assessed and managed over the phone Clinically active disease was managed remotely, with verbal history, biochemical results, and emergency endoscopy or intestinal ultrasound when required Ongoing collection of longitudinal data will add further insight into long-term outcomes from this rapid switch in care provision