Virtual care for Canadians living with IBD
Canadians with inflammatory bowel disease (IBD) who receive care from gastroenterologists have better outcomes, including lower risk of surgery or unplanned hospitalizations.1,2,3 However, individuals living in rural or remote areas are often underserviced and experience greater challenges in receiving timely access to care by a gastroenterologist, including having to travel greater distances to attend their appointments.4,5
Virtual care involves connecting a patient with their gastroenterologist, allowing for timely visits through phone calls or a secure online video platform. Studies6 have shown that virtual care helps to reduce the gap in access to timely IBD care and improve health outcomes for those who live in remote and underserved communities across Canada. Virtual care in IBD was also correlated with better sense of control over IBD symptoms, adherence, self-efficacy and knowledge about IBD.7,8
Canadian Network for Virtual Access to Specialists - Inflammatory Bowel Disease (CaNVAS-IBD)
To decrease wait times and unplanned hospitalizations for individuals living in rural or remote communities, CaNVAS-IBD has established six virtual care hubs at an IBD Centre of Excellence in different provinces. Each virtual care hub is led by a gastroenterologist and virtual care coordinator. Through these hubs, people with IBD can connect virtually with their gastroenterologist through phone calls or a secure online video platform.
An IBD Centre of Excellence is a clinic where a multidisciplinary team of healthcare providers work together to deliver specialized care in the treatment and management of IBD. Through CaNVAS-IBD, individuals can connect and visit with an IBD healthcare team in a timely manner. They will also have access to a multidisciplinary team that could include surgeons, IBD nurses, dieticians, psychologists, social workers and other specialists.
Crohn’s and Colitis Canada & PACE
Crohn’s and Colitis Canada (CCC) is the only national, volunteer-based charity focused on finding the cures for Crohn’s disease and ulcerative colitis and improving the lives of children and adults affected by these diseases. Our mission is to
Invest in Crohn’s and colitis research to foster advances in prevention, treatments, cures and health policy
Educate patients, families, industry and governments about Crohn’s and colitis, and improve the quality of life of those affected by these chronic diseases
Increase public awareness of these chronic diseases and our organization
The Promoting Access and Care through Centres of Excellence (PACE) network brings together leading inflammatory bowel disease (IBD) centres from across the country to improve health outcomes, address gaps in care and develop solutions that can create changes in the public healthcare system.
Through PACE, Dr. Geoffrey Nguyen and his team at Sinai Health System piloted the Ontario IBD telemedicine program. CaNVAS-IBD aims to expand the Ontario IBD telemedicine program to a national IBD virtual care program, with virtual care hubs located in Alberta, Saskatchewan, Manitoba, Nova Scotia, Ontario and Quebec.
What is a virtual care hub?
Virtual care (telemedicine) hubs have been established in six provinces and are affiliated with an IBD Centre of Excellence. Each virtual carehub is led by a provincial gastroenterologist and a virtual care coordinator, who will facilitate virtual care for their respective provinces. The coordinated virtual care program will provide the highest level of expertise in diagnosing and managing Crohn’s disease and ulcerative colitis, including facilitating access to diagnostic tests and procedures. Each virtual care hub will utilize a multidisciplinary approach to promote person-centered care for individuals in underserved communities.
Where are the virtual care hubs located?
1. Dr. Geoffrey Nguyen (Sinai Health Systems, Toronto, Ontario)
2. Dr. Kerri Novak (University of Calgary, Calgary, Alberta)
3. Dr. Charles Bernstein (University of Manitoba, Winnipeg, Manitoba)
4. Dr. Sharyle Fowler (University of Saskatchewan, Saskatoon, Saskatchewan)
5. Dr. Waqqas Afif (McGill University, Montreal, Quebec)
6. Dr. Jennifer Jones (Dalhousie University, Halifax, Nova Scotia)
What is the role of a Virtual Care Coordinator?
The role of the Virtual Care Coordinator is to optimize virtual workflow, coordinate plans of care and provide excellent clinical care in the management of IBD. In addition to real-time virtual visits with Virtual Care Coordinators and IBD specialists, the Virtual Care Coordinator provides patients with information, education and support to empower them to make informed decisions and assume an active role in the decision-making process.
The Virtual Care Coordinator is typically the first point of contact for IBD patients and serves as the care coordinator, communicating with the IBD healthcare team and the patient to ensure that the treatment plan is triaged appropriately and carried out. The Virtual Care Coordinator also helps with patient education on the disease process and treatments, motivates patients to ensure adherence to their treatment plan, ensures continuity of care and are resourceful listeners who can provide patients with emotional support and clinical advice.
How are telemedicine/video conferencing appointments set?
Upon triage of the referral, the Virtual Care Coordinator will arrange an appointment and contact the patient to gather additional health information. Based on the patient’s residential address and provincial system, the Virtual Care Coordinator identifies whether the patient can benefit from a virtual home visit or attend the nearest virtual care hub. The Virtual Care Coordinator will also ensure the arrangement of clinical follow-up as needed.
Facilitating the virtual care appointment.
Virtual Care Coordinator:
Ensures patient privacy and confidentiality throughout virtual visits.
Orients patients to the structure of the program, clinical protocol and staff.
Facilitates appropriate physical assessment and interim history taking during the appointment.
Collects the required health records and maintains access during the appointment for IBD specialists.
Coordinates with IBD specialists at the virtual care hub to provide their clinical expertise.
Ensures a successful virtual visit and troubleshoots technological difficulties as needed
Preserves patient privacy by closing the door and hanging the “Session in Progress” sign.
Informs the patient that the Consultant will be on a secure encrypted network and will not record the session without the patient’s consent.
Informs the patient of individuals present in the room.
Maintains access to Electronic Medical Record (EMR) throughout the virtual care (VC) appointment.
Ensures the receipt of physical assessment from telemedicine studios if applicable.
Troubleshoots technological problems as needed.
The Virtual Care Coordinator will confirm with the Consultant about any testing and follow-up for the patient prior to concluding the session and will ensure the execution of the plan of care. The Virtual Care Coordinator communicates a summary of the plan of care via an email to the patient. This email will include the outcome of the consultation (i.e. follow-up appointment, additional tests, prescriptions, referrals).
Documentation and Reporting:
Consultations should be documented as part of a patient record, following the same guidelines and standards as traditional face to face patient visits. The Virtual Care Coordinator’s assessment is filed in patients’ Electronic Medical Records (EMR) alongside consultation notes. The Virtual Care Coordinator assessment (Appendix A) includes vital signs assessment, basic skin assessment, abdominal assessment, weight and medication record.
After the Consultation:
The Virtual Care Coordinator provides the patient with a brief written summary of their plan of care. They also follow up with patients to help coordinate elements of their care plans, such as arranging lab tests, diagnostic imaging, and referrals to other health related services.
1.Benchimol EI, Manuel DG, Mojaverian N, et al. Health services utilization, specialist care, and time to diagnosis with inflammatory bowel disease in immigrants to Ontario, Canada: A population-based cohort study. Inflamm Bowel Dis. 2016;22(10):2482-2490.
2.Nguyen, GC, Nugent, Z, Shaw, S, & Bernstein, CN. Outcomes of patients with Crohn's disease improved from 1988 to 2008 and were associated with increased specialist care. Gastroenterology, 2011;141(1), 90-97.
3. Schoepfer AM, Dehlavi MA, Fournier N, et al. Diagnostic delay in Crohn’s disease is associated with a complicated disease course and increased operation rate. Am J Gastroenterol. 2013;108(11):1744-1753
4.Benchimol, EI, Kuenzig, ME, Bernstein, CN, Nguyen, GC, Guttmann, A, Jones, JL, ... & Canadian Gastro-Intestinal Epidemiology Consortium. . Rural and urban disparities in the care of Canadian patients with inflammatory bowel disease: a population-based study. Clinical epidemiology, 2018;10, 1613.
5. Benchimol, EI, Bernstein, CN, Nguyen, GC, Targownik, L, Guttmann, A, Jones, J, ... & Kaplan, GG. A31 disparities in the care of rural and urban Canadians with inflammatory bowel disease: a population-based study. Journal of the Canadian Association of Gastroenterology, 2018;1(suppl_2), 51-52.
6. Habashi, P, Bouchard, S, & Nguyen, GC. Transforming access to specialist care for inflammatory bowel disease: the PACE telemedicine program. Journal of the Canadian Association of Gastroenterology, 2019;2(4), 186-194.
7.Castro HK, Cross RK, Finkelstein J. Using a Home Automated Telemanagement (HAT) system: Experiences and perceptions of patients with inflammatory bowel disease. AMIA Annu Symp Proc2006:872.
8.Cross RK, Jambaulikar G, Langenberg P, et al. TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD): Design and implementation of randomized clinical trial. Contemp Clin Trials2015;42:132–44.