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How COVID-19 Impacts Care of Patients with Chronic Liver Disease

Tracey Simon, MD, MPH
Instructor of Medicine, Harvard Medical School
Assistant Professor, Gastroenterology
Massachusetts General Hospital
Boston, MA

Adapting Practice Patterns Among COVID-19

I take care of patients with chronic liver disease, several of whom have cellular carcinoma. We’ve faced a lot of challenges in the last few months with patients who have needed to stay at home, patients who have wanted to stay at home out of fear of coming into the hospital, or patients who’ve had to come into the hospital anyway, despite the fact that we’ve been sheltering in place now in Boston for seven weeks.

For us, some of the challenges relate to the fact that when you have cirrhosis, one of the things that’s very important is that we screen you for liver cancer, with an ultrasound, or sometimes with cross sectional imaging every six months. And there have been delays in access to care as outpatient imaging procedures, just like outpatient procedures in many cities across the country have ground to a halt with COVID-19. And so trying to make sure that we keep track of our patients and keep track of what it is that they need, and what has been delayed for them has been a very big challenge for our group.

We have an amazing staff here and are truly fortunate that we have lists and backup lists and people who are prioritizing and rescheduling patients actively starting early in the morning and well into the evenings. And now that we’re past the surge, our attention has started to shift as we start to think about how we’ll reopen, to how we’ll get caught up in terms of all of the patient care that had to be delayed. And so that’s been probably the greatest challenge in terms of care of patients with liver disease during this time.

Telemedicine

We moved very quickly to a virtual platform, and I do not even believe I missed a week of clinic. The transition was very rapid and far more rapid than hospitals usually are able to ramp up large-scale roll outs of new equipment or new platforms. It was very impressive how the University Hospital System was able to adapt and accommodate this need. We now have a few integrated platforms with which we are able to see patients.

For patients who may not have internet access at home, we have been doing telephone-based visits. But those who do, who are able to have a video connection in some way, we’ll do video visits. There are patients who are on critical research studies here who have been doing their study visits virtually by video with the study coordinators and the treating physician on the research protocol.

I expect and hope that some of that will continue as I think there is definitely a place for that in practice. Our patients who come from far away and who are driving down from Maine, coming across New York State, or coming from Rhode Island, it’s just not practical necessarily to have so many repeat visits, when the same type of visit could be accomplished virtually– especially if we’re able to see one another.

There are obviously times when an in-person visit is absolutely what’s required, but there are also times where it’s not. I think we’ve started to distinguish between those requirements a little bit better than we used to, when we just assumed an in-person visit always was necessary. In particular, for patients who are on any type of immunosuppression, regardless of how far away they live, the opportunity to have some of those unnecessary visits translated to a virtual platform is appropriate. I think that’s potentially a silver lining that has come out of this because otherwise we potentially would have been a lot slower to adapt to that sort of a need.


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