Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.274
Peer-review started: March 17, 2021
First decision: May 2, 2021
Revised: June 8, 2021
Accepted: December 28, 2021
Article in press: December 28, 2021
Published online: January 27, 2022
In December 2019, the coronavirus disease-2019 (COVID-19) emerged and rapidly spread worldwide, becoming a global health threat and having a tremendous impact on the quality of life (QOL) of individuals. In Italy, measures were enforced aimed at the reduction of inappropriate access to healthcare centres, which were considered as environments at a potential risk of crowding and viral infection spread.
All patients affected by chronic liver disease (CLD) experienced a substantial change in their usual routine care. As emerged from the survey by the Italian Association for the Study of the Liver, the reorganization of the health-care system, which followed the pandemic phase, has severely affected the management of liver diseases in Italy.
We wanted to evaluate the awareness of patients with CLD regarding the COVID-19 emergency and how it impacted on their QOL, and on their interaction with the healthcare system and planned follow-up programmes. Furthermore, we assessed whether for patients with autoimmune liver diseases the lack of contact with the specialist weighed on the management of their therapy.
Participants were asked to complete a two-part questionnaire, administered by telephone according to governmental restrictions: The first section assessed patients’ basic knowledge regarding COVID-19; the second evaluated the impact of the COVID-19 emergency on their QOL. We used the Italian version of the CLD questionnaire (CLDQ-I). With the aim of evaluating possible changes in the QOL items addressed, the questionnaire was administered to patients at the time of telephone contact with the specific request to recall their QOL perceptions during two different time periods.
The majority (93.8%) of patients were aware of COVID-19 transmission modalities and on how to recognize the most common alarm symptoms (93.8%). Five (15.6%) of 32 patients with autoimmune liver disease reported having had the need to receive more information about the way to manage their liver disease therapy during lockdown and nine (28.2%) thought about modifying their therapy without consulting their liver disease specialist. About the impact on QOL, all CLDQ-I total scores were significantly worsened during time t1 as compared to time t0.
The rapid outbreak of the pandemic worldwide has had a significant, worsening impact on the QOL of patients with CLD, especially on those psychological areas involving states of worry/concern, sadness, and anxiety. We believe that the utmost observation emerging from of our study is the importance of maintaining a contact with patients, guaranteeing them a continuity of care. The spread of telemedicine with video call, telephone, e-mail, and fax made it possible to maintain a contact with them without the risk of infectious exposure inherent to the face-to-face approach.
The telemedicine has to be institutionalized by the hospital; however, ad hoc reimbursement codes are to be developed as well as dedicated booking agendas. This method can replace a face-to-face visit in many hepatological conditions such as compensated cirrhosis or in patients with ALD who have reached durable medical control of their disease, since in a scenario of substantial clinical stability, it is not necessary to carry out a physical examination of the patient but only to collect, even indirectly, clinical-laboratory parameters easily communicated by the patient himself.