The COVID-19 pandemic has raised many questions and concerns among patients and caregivers related to the management and monitoring of inflammatory bowel disease (IBD). Patients who learn about their health conditions and work with their clinical teams to adopt personalized treatment plans are more satisfied with their care and achieve better outcomes.

This practical toolkit is designed to support clinical teams in conducting educational sessions with patients (and their caregivers) focused on how to optimize IBD care while living through a pandemic. These sessions provide a secure and interactive setting in which providers lead their patients through conversations about:

• COVID-19 (eg, disease course, transmission, risk factors, tests, vaccines) • Whether IBD and its treatments raise the risk for COVID-19 infection and severe disease • How IBD care may change if a patient is exposed to or infected with COVID-19 • Navigating shared decision-making, self-management, and general health maintenance during the pandemic

The patient-friendly handouts included in this toolkit can be used to lead educational sessions for groups or guide one-on-one patient education counseling. Sessions can be conducted in person or virtually to give patients, caregivers, and providers an option to interact safely during the pandemic. Regardless of when or how you will host them, these informal sessions create a comfortable, nonjudgmental setting in which patients and their loved ones are able to ask questions, share concerns, and learn from each other’s experiences. Patients should be encouraged to participate throughout in order to facilitate important dialogue and allow the speaker to tailor the information to the patients’ baseline knowledge about IBD and COVID-19.

Furthermore, the slide deck includes key questions to ask regarding your patients’ experiences of living with IBD during a global pandemic in order to elicit their concerns. This open dialogue will ultimately help cultivate a shared understanding between you and your patients on how to optimally manage their condition in these unprecedented times.

Ultimately, the key goal of this program is to encourage patients with IBD to be active participants in their health care decisions, even during a global pandemic. This toolkit will empower patients to build a strong partnership with their provider, which will lead to higher treatment satisfaction and improved outcomes.

Patient handouts to facilitate education in group settings or in one-on-one counseling sessions, in person or virtually

What’s included in the toolkit?

A compilation of resources related to IBD and COVID-19 that providers and patients can access for additional information and support

www.primeinc.orgThis activity is provided by PRIME® Education. There is no fee to participate. This activity is supported by an educational grant from Abbvie, Inc.

OPTIMIZING IBD CARE DURING THE GLOBAL PANDEMIC: ENGAGING AND EMPOWERING PATIENTS

Overview

For additional CME/CE activities in IBD and other disease states, visit www.primeinc.org.

1. Crohn’s & Colitis Foundation (CCF) Patient Resources https://www.crohnscolitisfoundation.org/science-and-professionals/patient-resources

2. myCROHNSandCOLITISteam https://www.mycrohnsandcolitisteam.com

3. American Gastroenterological Association (AGA) IBD Patient Resources https://www.cghjournal.org/article/S1542-3565(20)30167-1/fulltext

4. American College of Gastroenterology (ACG) IBD Resources https://gi.org/topics/inflammatory-bowel-disease/#tabs1

5. Centers for Disease Control and Prevention (CDC) COVID-19 Resources https://www.cdc.gov/coronavirus/2019-nCoV/index.html

6. CDC Interim Public Health Recommendations for Fully Vaccinated People https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

Additional Resources for Patient Engagement and Education

www.primeinc.orgThis activity is provided by PRIME® Education. There is no fee to participate. This activity is supported by an educational grant from Abbvie, Inc.

Instructions to Obtain Credit Learning Objectives

• Assess the impact of the COVID-19 pandemic on patient-provider knowledge, perceptions, and practices about IBD treatment and self-management

• Implement leading principles, tools, and processes for engaging patients and caregivers in shared decision-making about IBD care before or after COVID-19 infection

• Incorporate team- and technology-based strategies for ensuring care continuation and communication between IBD patients and providers during the COVID-19 pandemic

Joint Accreditation StatementIn support of improving patient care, PRIME® is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education forthe healthcare team.

Interprofessional TeamsThis activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit for learning and change.

Physician Credit Designation StatementPRIME® designates this Enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

PA Credit Designation StatementPRIME® has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit. PAs should only claim credit commensurate with the extent of their participation.

Nurse Practitioner Accreditation StatementPRIME Education is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 060815. This activity is approved for 1.0 contact hour (which includes 0.23 hour of pharmacology).

Pharmacist Credit Designation StatementThis Application-based activity has been approved for 1.0 contact hour (0.1 CEUs) by PRIME® for pharmacists. The Universal Activity Number for this activity is JA0007144-0000-21-040-H01-P. Pharmacy CE credits can be submitted to the NABP upon successful completion of the activity by providing your NABP ID & DOB, which must be submitted within 60 days of completion. Pharmacists with questions can contact NABP customer service (help@nabp.pharmacy).

Nurse Credit Designation StatementPRIME® designates this activity for 1.0 contact hour.

Case Manager Accreditation StatementThe Commission for Case Manager Certification designates this educational activity for 1.0 contact hour for certified case managers. Credits for this program are pre-approved.

Release Date: March 24, 2021

Thank you for presenting this patient education program titled “Optimizing IBD Care During the Global Pandemic: Engaging and Empowering Patients” in your clinic. We hope these materials will help increase patients’ engagment in their health care decisions and care plans for years to come.

1. Complete the activity in its entirety.2. Visit PRIME®’s Credit Center at

www.primeinc.org/credit.3. Enter program code 11PR211.4. Upon completion of the learner assessment tools,

you will be able to print or save an electronic copy of your certificate.

www.primeinc.orgThis activity is provided by PRIME Education. There is no fee to participate. This activity is supported by an educational grant from AbbVie, Inc.

OPTIMIZING IBD CARE DURING THE GLOBAL PANDEMIC: ENGAGING AND EMPOWERING PATIENTS

1

• Review the topics you plan to discuss as a group. • Encourage participants to share their own experiences and

ask questions throughout the program.• Ask participants what brought them here and what they hope

to get out of the program.

2

3

Main points• SARS-CoV-2 is the name of the virus. • COVID-19 is the name of the illness caused by SARS-CoV-2.• Point out what COVID-19 stands for.

4

Main points• Primary mode of transmission is close contact with an

infected person.• Although transmission can occur by touching infected

surfaces and then touching mouth nose or eyes, this is not believed to be a common way that COVID-19 spreads.

5

Main points• After exposure, there is an incubation period of about 5 days.• After that is the acute phase, when symptoms appear (list

common symptoms). The acute phase lasts about 5-10 days.• The pro-inflammatory phase is when one may experience low

oxygen levels and severe shortness of breath. This phase can last days to weeks.

• Last is recovery.

6

Main points• Diarrhea is a symptom of COVID-19 and in 20% of cases

diarrhea and nausea are the only symptoms.• It is therefore important to distinguish between an IBD flare

and COVID-19 symptoms.• Although the virus has been detected in feces, there is not

definitive proof that COVID-19 is transmitted this way.• Nevertheless, it is a good idea to be extra vigilant about

practicing good bathroom hygiene.

7

Main points• There are several groups that are at higher risk of severe

disease if infected with COVID-19.• The risk of hospitalization and death generally increases with

advancing age groups.• Minority groups are at higher risk for infection,

hospitalization, and death compared with white non-Hispanic persons.

8

Main points• There are certain conditions that place people at higher risk

of severe illness from COVID-19 infection (point out some conditions).

• The CDC also lists conditions which MAY put someone at increased risk of severe disease, but more information is needed. This list can be viewed at the URL.

9

Main points• IBD itself does not put you at a higher risk compared with the

general population.• Risk factors for ICU and death in IBD patients include

moderate to severe IBD and 2 or more additional medical conditions.

• Risks of IBD treatments will be addressed in next section.

10

Main points• There are 2 types of tests to determine if you have or have

had COVID-19.• A viral test can tell you if you have an active infection. Can be

a PCR test or antigen test. • An antibody test can tell you if you have been infected in the

past.• Get tested if you have symptoms of COVID-19, don’t just

assume it is allergies or an IBD flare.• Get tested if you have been exposed to someone who has

COVID-19, even if you feel ok.• Get tested if you have traveled or attended large social

gatherings, even if you feel ok.• The best way to get tested is to contact your health provider

and/or your state or local health department.

11

Main points• The 2 types of tests that can detect an active COVID-19

infection are PCR tests and antigen tests.• PCR tests detect the virus’s genetic material, antigen tests

detect proteins on the surface of the viruses.• Both types of tests have advantages and disadvantages. • Antigen tests give results quickly and can detect the most

infectious individuals, but false negatives can occur. • PCR tests are highly accurate, but may be positive beyond

when an individual is infectious.

12

Main points• Another type of test is an antibody test, which can tell you if

you have had an infection in the past.• Curves show when it is best to get each type of test.• Antigen tests have narrow window for detection and can

detect most infectious individuals.• PCR tests have a larger window because they can detect small

amounts of viral genetic material. They can be positive long after an individual stops being infectious.

• The best time to get a diagnostic test (PCR and antigen) is 5-7 days after exposure.

• The best time to get an antibody test is at least 3 weeks from symptom onset.

• Positive antibody tests should not be viewed as permission to ignore safety precautions.

13

Encourage participants to share their own experiences.Speakers can have discussion between each other to make patients more comfortable if they do not share right away.

14

15

Main points• There are 4 medication classes; they all work differently.• Aminosalicylates and corticosteroids work by reducing

inflammation.• Corticosteroids carry a high risk of side effects.• Immunomodulators calm an overactive immune system.• Targeted treatments work by interacting directly with specific

molecules. They Include injectable biologics and an oral JAK inhibitor.

16

Main points• You don’t have to go through every detail on slide--just give

some examples of commonly used drugs in each class.• Patients may be more familiar with brand names than

generics.

17

Main points• Steroids are associated with greatest risk of ICU, ventilator

use, and death.• TNF inhibitor monotherapy is associated with milder COVID-

19 symptoms.

18

Main points• These are recommendations from IOIBD.• Walk through the recommendations for each scenario.• These are meant to be a guide; decisions should be made on

a case-by-case basis based on severity of IBD activity and COVID-19 symptoms.

• Do not make any changes to your treatment without talking to your IBD care team.

19

Main points• Do not switch to home infusion or injectable treatment.• Make sure infusion center is following the recommended

safety precautions listed.

20

Encourage participants to share their own experiences.Speakers can have discussion between each other to make patients more comfortable if they do not share right away.

21

22

Main points• Do not neglect your IBD self management during the

pandemic.• It is very important to make sure you are managing your

stress and taking care of your mental health.

23

Main points• Vaccines, cancer screenings, bone health, and follow up visits

are very important for IBD care and should not be neglected during the pandemic.

• Talk to your IBD care team about keeping up with these aspects of health maintenance.

24

Main points• Here are some questions that would be good to ask your IBD

provider regarding your IBD care and the pandemic.• Bring a pen and sufficient paper to take as many notes as

possible.• Do not be afraid to speak up if you are not happy or are

uncomfortable with any aspects of your care.

25

Main points• Telemedicine has been critical for the continuity of care for

IBD patients during the pandemic.• It has been established as feasible and effective for IBD

patients.

26

Main points• If your insurance has changed or you lost your coverage, talk

to your IBD care team, they can help.• There are multiple options to help you with continuing to

access your medications.

27

Encourage participants to share their own experiences.Speakers can have discussion between each other to make patients more comfortable if they do not share right away.

29

Main points• 3 vaccines have an EUA.• An EUA makes it possible for quicker availability of medical

products during public health emergencies.• There are still certain criteria that must be met, including

large studies.• The products continue to be monitored after an EUA is

granted.

30

Main points• Pfizer and Moderna vaccines are mRNA vaccines encoding a

genetically modified SARS-CoV-2 spike protein, triggering an immune response against SARS-CoV-2.

• J&J vaccine is an adenovirus delivering a piece of the genetic material that is used to make the SARS-CoV-2 spike protein, triggering an immune response.

31

Main points• Although the vaccines have different storage requirements

and dosing schedules and work differently, they are all effective against COVID-19 and are great options.

• Even with a quick approval, they went through all 3 phases of clinical trials that included tens of thousands of individuals.

32

Main points• There are no serious safety concerns with any of the currently

available vaccines.• Only contraindications are severe allergic reactions to any

component of each vaccine.• Side effects such as fever are a good sign. It means the

vaccine is working.

33

Main points• Walk through points on the slide.• Take-home message is that there are no concerns with getting

the vaccine if you have IBD.

34

Main points• Walk through guidance on the slide, including the criteria to

be considered fully vaccinated.• Fully vaccinated people can have some restrictions lifted, but

there are still precautions they should continue to take for the time being.

35

Main points• IBD patients who are not vaccinated should continue to

follow the recommended safety precautions, such as wearing masks, physical distancing, washing hands frequently, and limiting contact with people outside of household as much as possible (unless they are vaccinated and you and no one in your household has risk factors for severe COVID-19).

36

Main points• This is a registry to examine the efficacy and safety of COVID-

19 vaccines among IBD patients.• Surveys will be sent every 3 months, with an option to get

antibody levels checked.• You can join through the website, by calling or emailing the

contact info listed, or scanning the QR code.

37

Encourage participants to share their own experiences.Speakers can have discussion between each other to make patients more comfortable if they do not share right away.

38

Main points• Go through lists of what to do and what not to do in terms of

managing your IBD care during the pandemic.

Encourage participants to share their own experiences and ask any remaining questions they may have.