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Inflammatory bowel disease patient concerns and experiences on transition to home-based infusions during the COVID-19
Janson Jacob1, Daniel Aintabi2, Melissa DeJonckheere3
1Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.
Insights
Patients with inflammatory bowel disease found home-based infusions (H-BI) to be a positive experience, despite initial concerns. Most plan to continue H-BI post-pandemic, highlighting the need to address logistical barriers for successful H-BI implementation.
Area of Science:
- Gastroenterology
- Immunology
- Public Health
Background:
- COVID-19 pandemic prompted social distancing measures, including home-based infusions (H-BI).
- Inflammatory bowel disease (IBD) patients were transitioned to H-BI for infliximab or vedolizumab infusions.
Purpose of the Study:
- To evaluate patient perceptions, concerns, and experiences with H-BI.
- To identify barriers and facilitators for successful H-BI implementation in IBD patients.
Main Methods:
- Mixed methods evaluation of 57 IBD patients (18-90 years) transitioned to H-BI.
- Semi-structured interviews analyzed using thematic approach.
- Collection of baseline data on safety, COVID-19 transmission, infusion delays, and H-BI persistence.
Main Results:
- 20 out of 57 participants responded (33%).
- Four categories and six themes emerged regarding expectations, experience, safety, and logistics.
- One COVID-19 case, one adverse event, 12% infusion delays, and 6% H-BI transitions from H-BI occurred.
- Most respondents reported positive experiences and planned to continue H-BI.
Conclusions:
- IBD patients generally had positive experiences with H-BI, with most intending to continue.
- Actionable barriers in scheduling, communication, and nursing quality were identified.
- No significant safety concerns were noted, supporting H-BI as a viable alternative.
Background:
In response to the COVID-19 pandemic, the CDC issued guidance advising patients and providers to adopt social distancing practices such as home-based infusions (H-BI).
Methods:
We performed a mixed methods evaluation to summarize perceptions, concerns, and experiences with H-BI among all inflammatory bowel disease patients 18-90 years of age who transitioned to home-based infliximab or vedolizumab infusions between March to July 2020 at a tertiary care center. Semi-structured interviews were conducted and analyzed using an iterative, inductive thematic approach. Baseline characteristics and outcome on safety, COVID-19 transmission, delays in infusions, and H-BI persistence were collected.
Results:
Of the 57 participants who transitioned to H-BI, 20 (33%) responded. Four major categories and six major themes related to expectations, experience, perceived safety, and logistical factors were identified. Initial perceptions were mixed, however these resolved. One patient developed COVID-19, one patient experienced an adverse event, 12 (21%) patients experienced an infusion delay, and 6 (11%) patients transitioned from H-BI.
Discussion:
Despite mixed initial perceptions, respondents had a positive experience with most respondents planning to continue H-BI after the pandemic resolves. Several real-world actionable barriers were identified related to scheduling, communication between stakeholders, and nursing quality. No major safety concerns were identified.
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