The sustainability and environmental impact of virtual care for inflammatory bowel disease: a population-based retrospective cohort study

Background — The COVID-19 pandemic prompted rapid expansion of virtual specialist care, yet its sustainability and environmental implications remain unclear. We evaluated temporal trends in virtual inflammatory bowel disease (IBD) care and quantified associated reductions in travel-related carbon emissions.

Methods — We conducted a population-based cohort study of individuals with IBD in Ontario, using linked ICES administrative data. Individuals with established IBD as of April 1, 2020, were followed through March 31, 2025. Outcomes included quarterly rates of virtual IBD specialist visits per 100 IBD capita, the proportion delivered virtually, and estimated carbon emissions avoided from reduced travel. Logistic regression identified predictors of ongoing virtual care.

Results — Among 98 099 individuals with IBD, 95% of specialist encounters among 62 265 patients with any visit were virtual during the first pandemic fiscal year. Virtual visit rates declined after 2021 and stabilized at approximately one-third of encounters by 2023-2025, while total ambulatory rates were modestly lower than pre-pandemic baseline. Of patients with a virtual visit in 2020-2021, 28% had one in 2023-2024. Older age, lower comorbidity, and residence in low-access regions were associated with reduced odds of continued virtual care. In the first pandemic year, virtual care was estimated to avoid 1268 tonnes of CO2 emissions, equivalent to the annual emissions of 275 passenger cars.

Conclusions — Virtual IBD specialist care was associated with substantial reductions in estimated travel-related carbon emissions, which diminished as care returned to in-person delivery. Sustainable hybrid care models may preserve environmental benefits while maintaining specialist access.