Patterns of specialist healthcare delivery among inflammatory bowel disease patients in response to the COVID-19 pandemic in Ontario: a population-based study

Background: Access to inflammatory bowel diseases (IBD) specialist care is a predictor of health outcomes. We sought to characterize the impact of the pandemic on patterns of IBD healthcare delivery and whether it compromised overall access to care. Methods: We identified adults with an IBD diagnosis residing in Ontario between 2016 and 2021 using administrative data at ICES. We determined quarterly rates of in-person and virtual IBD specialist visits and stratified that by regions with high and low access to IBD specialists. We stratified our analyses into 3 periods: pre-COVID, immediate COVID, and maintenance COVID. We performed interrupted time series analysis to assess for time trends. Results: During the immediate COVID phase, there was a 69% relative quarterly decline in in-person IBD specialist visits with a concurrent 591% relative quarterly rise in rates of virtual visits. Entering the COVID maintenance phase, there was a 7% quarterly relative decline in the rate of in-person visits, and a 7% and 4% quarterly relative increases in the rates of virtual and total IBD specialist visits, respectively. Pre-pandemic, IBD patients residing in regions with high specialist access had a 16% higher rate of visits than those in low-access regions. During the COVID maintenance phase, the disparity was reduced to 12%. Conclusions: During the COVID-19 pandemic, the rapid transition from in-person to virtual IBD specialist care led to a slight increase in overall IBD visits. There was also a small decrease in the gap in rates of IBD specialist visits between high- and low-access regions.