Impact of the Distance Approach on the Management of Patients With Inflammatory Bowel Disease (IBD) in the Outpatient and Infusion Centers of a Tertiary Hospital in Northeast Brazil

Background: The coronavirus disease 2019 (COVID-19) pandemic had an impact on the Brazilian public health system, particularly in references centers. In 2020 most face-to-face appointments had to be rescheduled to diminish the spread of covid-19 for patients with inflammatory bowel disease. However, a portion of patients with IBD, especially those with severe phenotype, needed to be seen in person and receive biologics infusion therefore we developed a screening protocol for covid-19 especially during the peak of 2020 pandemic cases. Methods: The objective was to evaluate the impact of the application of the COVID-19 screening protocol carried out by a multidisciplinary team in the care of patients with IBD in specialized outpatient clinic and in immunobiological infusion of a reference center in Northeast of Brazil. A multidisciplinary team work, by telephone call, was carried out using a specific flowchart to direct patients with IBD at a reference center in the state of Ceara, Brazil during the peak of COVID-19 cases in 2020. Three days before the consultation or infusion, over the phone, screening for flu-like symptoms was performed. The consultation or infusion was rescheduled (14 to 28 days) for patients with flu-like symptoms and these patients were monitored by telephone call. Consultation of outpatients with no flu-like symptoms and no signs of IBD activity was scheduled at 3 to 6 months. Patients without flu-like symptoms and with relevant IBD activity (based on patient-reported outcomes – PROs) were indicated for face-to-face consultation. As for patients who had scheduled infusions, the need to continue IBD treatment was reinforced, unless they had flu-like symptoms. In 2021, the COVID-19 screening protocol was not applied due to structural limitations. Next, a retrospective study was carried out comparing the number of face-to-face consultations during the first wave of COVID-19 in 2020 versus the second wave of COVID-19 in 2021. The application of screening was considered the main difference between the groups studied. Data analysis was performed using the chi-square test in SPSS Statistics (IBM Corporation). Results: The attendance rate of 48.5% in face-to-face consultations carried out during the COVID 2020 wave was lower than 73.4% of those carried out during the COVID 2021 wave (P< 0.001). There was no difference in the proportion (85.1%) of attendance at consultations in the period out of the COVID wave in 2020 versus 84.3% in the period out of the COVID wave in 2021 (p=0.804). The application of the COVID screening protocol to patients at the infusion center was also important, thus it avoided unnecessary absences and maintained the average number of infusions in almost all months studied. Conclusions: In a country with continental dimensions like Brazil, we observed the importance of distance approach as a tool to evaluate patients with IBD, and based on the patients report outcome (PRO) we directed them to face-to-face care or not, in order to control the spread of virus