The impact of the coronavirus disease 2019 (COVID-19) pandemic has created new challenges worldwide for the pediatric gastroenterology community. These findings were reported in a study published in Gastroenterology.
A team of investigators conducted a study to assess the effects of COVID-19 on pediatric gastroenterology practice in an effort to develop strategies to prepare for a future resurgence and/or pandemic.
In July and August 2020, a web-based survey was distributed to pediatric gastroenterology division and group heads (DGHs) by the European and North American Societies for Pediatric Gastroenterology, Hepatology, and Nutrition, as well as through a listserv targeting pediatric gastroenterologists worldwide. The 45-question pretested, anonymous survey consisted of questions regarding division/group demographics, pandemic-related changes to practice and care delivery, financial implications and mitigating solutions, priorities during reopening, and lessons learned.
Among the 116 DGHs representing 20 countries, 67.2% (n=78) were from North America (91.8% response rate, n=78/85), 25.9% (n=30) from Europe, and 6.9% (n=8) from other continents. The majority of DGHs’ representation were from academic institutions (91.4%, n=106) located in an urban setting (85.3%, n=99), with more then half situated in free-standing children’s hospital (52.6%, n=61).
Compared to the year prior, the peak of the pandemic was causally linked to a substantial decrease in endoscopy services with 77.4% (89/115) reporting a >75% reduction in activity. Regarding ambulatory and inpatient services, a >75% reduction was reported by 48.6% (56/115) and 47.0% (54/115) of DGHs, respectively.
During the pandemic, 36.1% (39/108) of DGHs identified more severe presentations of typical diseases from delays in diagnosis. An increase in accidental ingestions were reported by 20% (22/108).
The financial implications of the pandemic were felt worldwide, with a decrease in revenue reported by nearly all DGHs (98.9%, 87/88). Strategies to mitigate the financial burden included cuts to bonuses, benefits, and salaries, which in turn, frequently affected physicians. However, permanent termination was considered rare.
The investigators found that the top-rated re-opening priorities of ambulatory services were management of patient flow and space capacity to maintain safety (59.5%, n=69), triage of postponed and new patients (55.2%, n=64), and to ensure continued access to telehealth (54.5%, n=63). Priorities related to endoscopy consisted of a triage of postponed procedures (81%, n=94), availability of preprocedural severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing (64.7%, n=75), and an ability to maintain safe patient flow and space capacity (47.4%, n=55).
Although COVID-19 has impacted care for children at multiple levels, successful pandemic-related implementations have emerged from this disruption of standard medical activity. DGHs reported the following successful pandemic-related implementations: “Virtual care (89.3%), patient triage and flow (38.7%), and virtual work environments (32.0%) as well as ongoing challenges (e.g., burnout), and recommended strategies to prepare for resurgences and/or another future pandemic.”
This study had several limitations, including the uncertainty of the overall response rate. Additional investigation is warranted to assess changes that were implemented after survey completion. Lasty, the United States cohort consisted entirely of institutions without centralized, statutory insurance, thus increasing observed differences.
“This is the first study to our knowledge to provide a comprehensive, international view of the pandemic from the perspective of physician leaders”, the study authors wrote.
Disclosure: One author declared affiliations with industry. Please refer to the original article for a full list of author disclosures.
Tam SS, Picoraro JA, Gupta SK, et al; International Pediatric Gastroenterology COVID-19 Alliance. Changes to pediatric gastroenterology practice during the COVID-19 pandemic and lessons learned: an international survey of division and group heads. Gastroenterol. Published online March 3, 2021. doi: 10.1053/j.gastro.2021.02.064