N03 Flexibility & Accessibility, e-Literacy, Resourcing and The Human Factor: Early Lessons from EIBD, a UK Qualitative Interview Study

Abstract

Background Since the COVID-19 pandemic, the use of health tools (video/phone consultations, patient portals, and digital applications) has increased in the clinical management of patients with Inflammatory Bowel Disease (PIBD). We aimed to evidence the acceptability of eHealth tools by investigating the shared experience of PIBD and healthcare professionals (HCPs) in using eHealth to carry out follow-up appointments and support self-management. Methods An exploratory qualitative method was used. Participants were recruited via professional networks, social media platforms, Crohn's and Colitis UK website and newsletters. Semi-structured interviews were conducted remotely in April/May 2023 using MS Teams or Zoom. Transcripts were analysed using a thematic analysis. Results Fifteen HCPs (13 female) participated: IBD specialist nurses (n=9); gastroenterologists (n=2), pharmacists (n=2) and Dieticians (n=2). The 16 PIBD (10 female) participants were living with Crohn’s Disease (n=9), Ulcerative Colitis (n=6), and Inflammatory Bowel Disease Unclassified (n=1); age was reported in ranges 18 -24 (n=3), 24-34 (n=1), 35-54 (n=8), and 55-65 (n=2) and 75-85 (n=1). Time since IBD diagnosis ranged from < 6 months - 43 years (mean time 18.7 years). Some participants had pre-diagnosis symptoms for at least one year (81%) to over five years (25%). Four themes emerged: • Flexibility and Accessibility: PIBD appreciated the ease of virtual appointments and access to test results and information but wanted flexibility and a personal approach to their care; eHealth connected them to their IBD team more easily. • Resource: HCPs wanted better digital training since remote assessment skills differ from in-person assessment skills. They also identified the need for admin support when planning to implement eHealth tools. HCPs and PIBD wondered whether eHealth was primarily a cost-savings exercise, whilst the need for resource efficiencies across the health service was recognised. • e-Literacy: HCPs were concerned that some older PIBD might be excluded from accessing eHealth due to e-literacy and capability issues, perceiving that eHealth is for the younger generation. • The Human Factor: PIBD and HCPs wanted to have already met in person anyone they engaged with later virtually. For PIBD, in-person consultations meant they felt seen or understood, and they described the importance of hands-on abdominal examinations in reassuring them about their health status. Conclusion There is an acceptability of eHealth to support the care of PIBD, but HCPs and PIBD still value the Human factor. Concerns over Resourcing, Flexibility and Accessibility and e-Literacy may need addressing to avoid these becoming barriers to the benefits of virtual healthcare in supporting PIBD.