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Aguas Peris M, Del Hoyo Francisco J, Nos Mateu P, Echarri Piudo A, Calvo Moya M, Gros B, Martín-Arranz MD, Monte Boquet E, Inglán Agustín S, Valdivia Martínez A, Correcher M, Barreiro-de Acosta M, Mañosa Ciria M, Rodriguez-Moranta F, Zabana Y, Gutiérrez Casbas A. Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis on the use of Telemedicine in Inflammatory Bowel Disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2025; 48:502320. [PMID: 39672505 DOI: 10.1016/j.gastrohep.2024.502320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Accepted: 12/08/2024] [Indexed: 12/15/2024]
Abstract
Inflammatory Bowel Disease (IBD) is a chronic digestive condition that requires continuous monitoring by healthcare professionals to determine appropriate therapy and manage short- and long-term complications. Telemedicine has become an essential approach for managing chronic conditions such as IBD, improving care accessibility and continuity, decreasing hospitalization rates, and optimizing patient follow-up. It enables rapid treatment adjustments and encourages patient self-management. Additionally, it reduces the burden on the healthcare system by decreasing unnecessary in-person visits and provides real-time support, thereby improving quality of life and clinical outcomes. The objective of this position statement by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) is to establish recommendations for the use of telemedicine in its different modalities (teleconsulting, telemonitoring, mobile applications and telepharmacy) for patients with IBD and address the legal, ethical, and technical aspects necessary for its proper implementation.
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Affiliation(s)
- Mariam Aguas Peris
- Servicio Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IISLaFe), Valencia, España.
| | - Javier Del Hoyo Francisco
- Servicio Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IISLaFe), Valencia, España
| | - Pilar Nos Mateu
- Servicio Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe (IISLaFe), Valencia, España
| | - Ana Echarri Piudo
- Servicio Aparato Digestivo, Complejo Hospitalario Universitario Ferrol, A Coruña, España
| | - Marta Calvo Moya
- Servicio Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Beatriz Gros
- Servicio Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica (IMIBIC), Universidad de Córdoba, Córdoba, España; Centro de Investigación Biomédica en Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, España
| | - María Dolores Martín-Arranz
- Servicio Aparato Digestivo, Hospital Universitario La Paz, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Emilio Monte Boquet
- Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | | | - Marisa Correcher
- Departamento Sistemas de Información, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Miriam Mañosa Ciria
- Centro de Investigación Biomédica en Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, España; Servicio Aparato Digestivo, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, España
| | | | - Yamile Zabana
- Centro de Investigación Biomédica en Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, España; Servicio Aparato Digestivo, Hospital Universitario Mútua Terrassa, Barcelona, España
| | - Ana Gutiérrez Casbas
- Centro de Investigación Biomédica en Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, España; Servicio Aparato Digestivo, Hospital General Universitario Dr. Balmis e ISABIAL, Alicante, España
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Mercuri C, Giordano V, Bosco V, Serra N, Spagnuolo R, Nocerino R, Rea T, Colaci C, Guillari A, Doldo P, Simeone S. Impact of Nursing Interventions via Telephone and Email on the Quality of Life of Patients with Inflammatory Bowel Disease: Preliminary Results of a Comparative Observational Study. Healthcare (Basel) 2024; 12:2538. [PMID: 39765967 PMCID: PMC11675699 DOI: 10.3390/healthcare12242538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 12/10/2024] [Accepted: 12/13/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), encompassing ulcerative colitis and Crohn's disease, is a heterogeneous chronic condition characterized by periods of relapse and remission. Ulcerative colitis involves inflammation of the colon and rectum mucosa, while Crohn's disease causes deeper, transmural inflammation affecting all four gut layers from the mouth to the anus and can lead to complications such as fistulation. IBD significantly impacts patients' physical and psychological well-being, thus reducing their quality of life (QoL). We aimed to evaluate the effectiveness of nursing intervention facilitated through telephone and email support in improving the quality of life (QoL) of Inflammatory Bowel Disease (IBD) patients. METHODS A pilot comparative observational design with pre-test and post-test assessments was employed, involving 50 participants assigned to either an intervention group (Group A, n = 26) or a control group (Group B, n = 24). Group A received regular telephone consultations and prompt email responses from trained nurses; Group B received standard care. Data were collected at baseline and six months post-intervention (T1) using the Patient-Reported Outcomes Measurement Information System (PROMIS®) and Pittsburgh Sleep Quality Index. RESULTS Group A showed significant improvements in anxiety, depression, fatigue, and sleep quality, with p-values indicating the significance of these findings. CONCLUSIONS Tailored nursing support via remote communication significantly benefits IBD patients by alleviating psychological distress and enhancing their overall well-being, underscoring the importance of integrating such interventions into standard IBD care practices.
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Affiliation(s)
- Caterina Mercuri
- Department of Clinical and Experimental Medicine, University of Catanzaro MagnaGraecia, 88100 Catanzaro, Italy; (C.M.); (C.C.); (P.D.); (S.S.)
| | | | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Nicola Serra
- Department of Neuroscience, Reproductive Sciences and Dentistry-Audiology Section, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy;
| | - Rocco Spagnuolo
- Department of Health Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Rita Nocerino
- Department of Translational Medical Science, University of Naples “Federico II”, 80131 Naples, Italy;
- ImmunoNutritionLab at CEINGE—Advanced Biotechnologies, University of Naples “Federico II”, 80131 Naples, Italy
| | - Teresa Rea
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Carmen Colaci
- Department of Clinical and Experimental Medicine, University of Catanzaro MagnaGraecia, 88100 Catanzaro, Italy; (C.M.); (C.C.); (P.D.); (S.S.)
| | - Assunta Guillari
- Department of Translational Medical Science, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Patrizia Doldo
- Department of Clinical and Experimental Medicine, University of Catanzaro MagnaGraecia, 88100 Catanzaro, Italy; (C.M.); (C.C.); (P.D.); (S.S.)
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro MagnaGraecia, 88100 Catanzaro, Italy; (C.M.); (C.C.); (P.D.); (S.S.)
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Aguas M, Del Hoyo J, Vicente R, Barreiro-de Acosta M, Melcarne L, Hernandez-Camba A, Madero L, Arroyo MT, Sicilia B, Chaparro M, Martin-Arranz MD, Pajares R, Mesonero F, Mañosa M, Martinez P, Chacón S, Tosca J, Marín S, Sanroman L, Calvo M, Monfort D, Saiz E, Zabana Y, Guerra I, Varela P, Baydal V, Faubel R, Corsino P, Porto-Silva S, Brunet E, González M, Gutiérrez A, Nos P. Telemonitoring of Active Inflammatory Bowel Disease Using the App TECCU: Short-Term Results of a Multicenter Trial of GETECCU. J Med Internet Res 2024; 26:e60966. [PMID: 39189160 PMCID: PMC11612589 DOI: 10.2196/60966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/08/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Telemonitoring for inflammatory bowel disease (IBD) has not consistently demonstrated superiority over standard care; however, noninferiority may be an acceptable outcome if remote care proves to be more efficient. OBJECTIVE This study aims to compare the remission time and quality of life of patients with active IBD managed through standard care versus the TECCU (Telemonitoring of Crohn Disease and Ulcerative Colitis) app. METHODS A 2-arm, randomized, multicenter trial with a noninferiority design was conducted across 24 hospitals in Spain. The study included adult patients with IBD who were starting immunosuppressive or biological therapy. Participants were randomized into 2 groups: the telemonitoring group (G_TECCU) and the standard care group (G_Control). The follow-up schedule for the telemonitoring group (G_TECCU) was based on contacts via the TECCU app, while the control group (G_Control) adhered to standard clinical practice, which included in-person visits and telephone calls. In both groups, treatment adjustments were made based on the progression of disease activity and medication adherence, assessed using specific indices and biological markers at each check-up. The primary outcome was the duration of remission after 12 weeks, while secondary outcomes included quality of life, medication adherence, adverse events, and patient satisfaction. RESULTS Of the 169 patients enrolled, 158 were randomized and 150 were analyzed per protocol: telemonitoring (n=71) and control (n=79). After 12 weeks, the time in clinical remission was not inferior in the telemonitoring group (mean 4.20, SD 3.73 weeks) compared with the control group (mean 4.32, SD 3.28 weeks), with a mean difference between arms of -0.12 weeks (95% CI -1.25 to 1.01; noninferiority P=.02). The mean reduction in C-reactive protein values was -15.40 mg/L (SD 90.15 mg/L; P=.19) in the G_TECCU group and -13.16 mg/L (SD 54.61 mg/L; P=.05) in the G_Control group, with no significant differences between the 2 arms (P=.73). Similarly, the mean improvement in fecal calprotectin levels was 832.3 mg/L (SD 1825.0 mg/L; P=.003) in the G_TECCU group and 1073.5 mg/L (SD 3105.7 mg/L; P=.03) in the G_Control group; however, the differences were not statistically significant (P=.96). Quality of life improved in both groups, with a mean increase in the 9-item Inflammatory Bowel Disease Questionnaire score of 13.44 points (SD 19.1 points; P<.001) in the G_TECCU group and 18.23 points (SD 22.9 points; P=.001) in the G_Control group. Additionally, the proportion of patients who adhered to their medication significantly increased from 35% (25/71) to 68% (48/71) in the G_TECCU group (P=.001) and from 46% (36/79) to 73% (58/79) in the G_Control group (P=.001). The satisfaction rate remained stable at around 90%, although noninferiority was not demonstrated for the secondary outcomes. CONCLUSIONS Telemonitoring patients with active IBD is not inferior to standard care for achieving and maintaining short-term remission. The TECCU app may serve as a viable alternative follow-up tool, pending confirmation of improved health outcomes and cost-effectiveness over the long-term. TRIAL REGISTRATION ClinicalTrials.gov NCT06031038; https://clinicaltrials.gov/ct2/show/NCT06031038. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.9639.
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Affiliation(s)
- Mariam Aguas
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Javier Del Hoyo
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | | | | | - Luigi Melcarne
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | | | - Lucía Madero
- Dr Balmis General University Hospital, ISABIAL, Alicante, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - María Chaparro
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid, Madrid, Spain
| | - María Dolores Martin-Arranz
- La Paz University Hospital, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | - Miriam Mañosa
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Pilar Martinez
- San Cecilio Clinic University Hospital, Parque Tecnológico de la Salud, Granada, Spain
| | - Silvia Chacón
- Morales Meseguer General University Hospital, Murcia, Spain
| | - Joan Tosca
- Clinic University Hospital, Valencia, Spain
| | | | | | - Marta Calvo
- Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Empar Saiz
- Xarxa Assistencial University Hospital, Manresa, Spain
| | - Yamile Zabana
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Mútua Terrassa University Hospital, Terrassa, Spain
| | - Ivan Guerra
- Fuenlabrada University Hospital, Madrid, Spain
| | | | - Virginia Baydal
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Raquel Faubel
- Joint Research Unit in ICT Applied to Reengineering Socio-Sanitary Process, IIS La Fe-Universitat Politècnica de València, Valencia, Spain
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Universitat de València, Valencia, Spain
| | | | | | - Eduard Brunet
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Melodi González
- Nuestra Señora de la Candelaria University Hospital, Tenerife, Spain
| | - Ana Gutiérrez
- Dr Balmis General University Hospital, ISABIAL, Alicante, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
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Fantini MC, Loddo E, Petrillo AD, Onali S. Telemedicine in inflammatory bowel disease from its origin to the post pandemic golden age: A narrative review. Dig Liver Dis 2024; 56:1-6. [PMID: 37330279 DOI: 10.1016/j.dld.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/19/2023]
Abstract
Inflammatory bowel disease (IBD), a chronic intestinal inflammatory disorder encompassing ulcerative colitis and Crohn's disease can be disabling and often requires lifelong treatment and follow-up. Digital health technologies and distance-management tools are less costly alternatives for IBD management and clinical monitoring. This review discusses how telephone/videoconference appointments enable treatment optimization from an early disease stage, provide complementary value-based patient care and educational resources, and allow consistent follow-up with a high standard of care. Replacing/supplementing traditional clinical consultations with telemedicine reduces healthcare utilization costs and the need for in-person consultations. The COVID-19 pandemic has accelerated the evolution of telemedicine in IBD, with several studies conducted since 2020 reporting high levels of patient satisfaction. Home-based injectable formulations coupled with telemedicine may become permanently embedded in healthcare systems in the post-pandemic period. While telemedicine consultations are well-accepted by many patients with IBD, they do not suit all patients or are not preferred (e.g., by elderly who do not have the means or ability to understand the associated technology). Ultimately, use of telemedicine should be decided by the patient and careful consideration is required to ensure that the patient is willing and capable of a successful remote visit.
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Affiliation(s)
- Massimo Claudio Fantini
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy.
| | - Erica Loddo
- Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy
| | - Amalia Di Petrillo
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Sara Onali
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy
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Michel HK, Gorham TJ, Lee JA, Liu SB, Wright M, Maltz RM, Dotson JL. Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care. J Pediatr Gastroenterol Nutr 2023; 77:519-526. [PMID: 37501225 DOI: 10.1097/mpg.0000000000003903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Outpatient inflammatory bowel disease (IBD) care shifted from office visits (OVs) to a model with integrated telemedicine during the 2020 COVID-19 pandemic. We describe the impact of this shift on delivery of pediatric IBD care. METHODS We collected electronic medical record data from office and telemedicine visits for pediatric patients with IBD at a single center from April 2019 to December 2020. We compared visit volume, duration, and test ordering between 2019 and 2020, and between OV and telemedicine, and assessed for differences in telemedicine adoption by sociodemographic factors. RESULTS Visit volume was maintained between 2019 and 2020. Median overall appointment time was shorter for telemedicine versus OV [46 (interquartile range, IQR 35-72) vs 62 (IQR 51-80) minutes; P < 0.001] with no significant difference in time spent with provider [28 (IQR 21-41) vs OV 30 (IQR 24-39) minutes; P = 0.08]. Accounting for drive time, telemedicine visits were 2.6 times shorter than office visits in 2020 ( P < 0.001). In univariate analyses, there was no difference in telemedicine utilization by race or gender. Variables significantly associated with telemedicine were older age, English as primary language, being non-Hispanic, commercial insurance, living in an area of very high opportunity, and having a longer drive time to the office ( P < 0.05 for all comparisons). In multivariate analyses, visits among patients with commercial insurance were significantly more likely to be conducted via telemedicine ( P = 0.02). Among those with a telemedicine visit, multivariate analyses demonstrated multiracial patients were significantly more likely to have video visits (vs audio-only; P = 0.02), while patients with public insurance, no or missing insurance, and whose primary language was Arabic were significantly less likely to have video visits ( P < 0.05 for all comparisons). CONCLUSIONS Integrated telemedicine allowed for continued delivery of pediatric IBD care and significantly decreased appointment time. While telemedicine may improve access for those who live further from the office, concerns remain about the introduction of disparities.
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Affiliation(s)
- Hilary K Michel
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
| | - Tyler J Gorham
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer A Lee
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
- the Department of Biomedical Informatics, the Ohio State University, Columbus, OH
| | - Swan Bee Liu
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH
| | - Molly Wright
- the Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Ross M Maltz
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
| | - Jennifer L Dotson
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
- the Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
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Gravina AG, Pellegrino R, Durante T, Palladino G, D'Onofrio R, Mammone S, Arboretto G, Auletta S, Imperio G, Ventura A, Romeo M, Federico A. Telemedicine in inflammatory bowel diseases: A new brick in the medicine of the future? World J Methodol 2023; 13:194-209. [PMID: 37771865 PMCID: PMC10523254 DOI: 10.5662/wjm.v13.i4.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 09/20/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic digestive disease that requires continuous monitoring by healthcare professionals to determine the appropriate therapy and monitor short-term and long-term complications. The progressive development of information technology has enabled healthcare personnel to deliver care services to patients remotely. Therefore, various applications of telemedicine in IBD management have evolved, including telemonitoring, teleconsulting, teleducation, telenursing, telenutrition, and telepathology. While evidence has been provided for some telemedicine applications, targeted studies are still required. This review summarises the major studies that have evaluated telemedicine and its application in the management of IBD.
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Affiliation(s)
| | - Raffaele Pellegrino
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Tommaso Durante
- Mental Health Department, “S. Pio” Hospital, Benevento 82100, Italy
| | - Giovanna Palladino
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Rossella D'Onofrio
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Simone Mammone
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Giusi Arboretto
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Salvatore Auletta
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Giuseppe Imperio
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Andrea Ventura
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Mario Romeo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Alessandro Federico
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
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Kawakami A, Tanaka M, Sakagami K, Ito H. Content of Telephone Consultations of Patients With Inflammatory Bowel Disease: A Single-Center Descriptive Study. Gastroenterol Nurs 2023; 46:282-288. [PMID: 37224075 DOI: 10.1097/sga.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/20/2023] [Indexed: 05/26/2023] Open
Abstract
This study aimed to analyze the specific contents of telephone consultations of patients with inflammatory bowel disease. A medical record survey was conducted at a clinic in Japan for 1 year. Telephone consultation sheets recorded by nurses for calls with the patients or their relatives were reviewed. Content analysis was used to summarize the telephone consultation content. Consultations were categorized into 8 categories. Coding was conducted by 2 independent researchers. Concordance rates were evaluated using kappa coefficients. We analyzed 476 sheets. A total of 229 participants consulted the clinic at least once. The mean number of consultations per person was 2.1. Of these patients, 96 (40.9%) had ulcerative colitis. The kappa coefficient was 0.89. The most frequent consultation was "Consultation on worsening health: Inflammatory bowel disease is likely to have worsened" (42.0%). The second most frequent response was "Consultation or progress report on a worsening health condition: The disease is unlikely to have worsened" (19.8%). For consultations related to worsening the disease, it would be useful to assess symptoms over the phone using a disease activity index to ascertain the degree of worsening and to develop a screening tool for determining whether patients can continue remote support or require face-to-face consultation.
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Affiliation(s)
- Aki Kawakami
- Aki Kawakami, PhD, RN, PHN, is Associate Professor, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Makoto Tanaka, PhD, RN, PHN, is Professor, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Kayoko Sakagami, RN, is a head nurse at Kinshukai Infusion Clinic, Osaka, Japan
- Hiroaki Ito, PhD, MD, is a head of the clinic at Kinshukai Infusion Clinic, Osaka, Japan
| | - Makoto Tanaka
- Aki Kawakami, PhD, RN, PHN, is Associate Professor, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Makoto Tanaka, PhD, RN, PHN, is Professor, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Kayoko Sakagami, RN, is a head nurse at Kinshukai Infusion Clinic, Osaka, Japan
- Hiroaki Ito, PhD, MD, is a head of the clinic at Kinshukai Infusion Clinic, Osaka, Japan
| | - Kayoko Sakagami
- Aki Kawakami, PhD, RN, PHN, is Associate Professor, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Makoto Tanaka, PhD, RN, PHN, is Professor, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Kayoko Sakagami, RN, is a head nurse at Kinshukai Infusion Clinic, Osaka, Japan
- Hiroaki Ito, PhD, MD, is a head of the clinic at Kinshukai Infusion Clinic, Osaka, Japan
| | - Hiroaki Ito
- Aki Kawakami, PhD, RN, PHN, is Associate Professor, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Makoto Tanaka, PhD, RN, PHN, is Professor, Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Kayoko Sakagami, RN, is a head nurse at Kinshukai Infusion Clinic, Osaka, Japan
- Hiroaki Ito, PhD, MD, is a head of the clinic at Kinshukai Infusion Clinic, Osaka, Japan
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Del Hoyo J, Millán M, Garrido-Marín A, Aguas M. Are we ready for telemonitoring inflammatory bowel disease? A review of advances, enablers, and barriers. World J Gastroenterol 2023; 29:1139-1156. [PMID: 36926667 PMCID: PMC10011957 DOI: 10.3748/wjg.v29.i7.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 02/09/2023] [Indexed: 02/21/2023] Open
Abstract
This review summarizes the evidence about telemonitoring in patients with inflammatory bowel disease (IBD). To give an overview of the advances performed, as well as the enablers and barriers which favoured/hindered telemonitoring implementation. We performed a literature search in PubMed, EMBASE, MEDLINE, Cochrane Database, Web of Science and Conference Proceedings. Titles and abstracts published up to September 2022 were screened for a set of inclusion criteria: telemonitoring intervention, IBD as the main disease, and a primary study performed. Ninety-seven reports were selected for full review. Finally, 20 were included for data extraction and critical appraisal. Most studies used telemonitoring combined with tele-education, and programs evolved from home telemanagement systems towards web portals through mHealth applications. Web systems demonstrated patients’ acceptance, improvement in quality of life, disease activity and knowledge, with a good cost-effectiveness profile in the short-term. Initially, telemonitoring was almost restricted to ulcerative colitis, but new patient reported outcome measures, home-based tests and mobile devices favoured its expansion to different patients´ categories. However, technological and knowledge advances led to legal, ethical, economical and logistic issues. Standardization of remote healthcare is necessary, to improve the interoperability of systems as well as to address liability concerns and users´ preferences. Telemonitoring IBD is well accepted and improves clinical outcomes at a lower cost in the short-term. Funders, policymakers, providers, and patients need to align their interests to overcome the emerging barriers for its full implementation.
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Affiliation(s)
- Javier Del Hoyo
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Mónica Millán
- Department of Surgery, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Alejandro Garrido-Marín
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Mariam Aguas
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
- Health Research Institute La Fe, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
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9
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French experience with telemedicine in inflammatory bowel disease: a patients and physicians survey. Eur J Gastroenterol Hepatol 2022; 34:398-404. [PMID: 34860706 DOI: 10.1097/meg.0000000000002319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS The use of telemedicine dramatically increased during the COVID-19 pandemic. We collected patients and physicians experience on telemedicine in the field of inflammatory bowel disease (IBD). METHODS We conducted a nationwide survey between September 2020 and January 2021. A self-administered questionnaire was sent to participants through mailing lists of the national patients' association and IBD expert groups. RESULTS Overall, 300 patients and 110 gastroenterologists filled out the survey. On a 10 points scale of satisfaction with telemedicine, 60% of patients noted a score ≥8 and 52.7% of physicians ≥7. Patients and gastroenterologists felt that the duration of teleconsultations appeared to be shorter than in-person visits in 57.5 and 55.1% of cases, respectively. All participants agreed that telemedicine is appropriate in dedicated situations and not for flare-up consultations. For 55.1% of patients, quality of care was the same via telemedicine, whereas 51.4% of gastroenterologists believed they managed less well their patients. Lack of clinical examination being pointed out as the main limitation of telemedicine. Three-quarters of patients and gastroenterologists would agree to use telemedicine more often in the future. CONCLUSION Patients and gastroenterologists were satisfied with telemedicine and would be willing to use it in the future. However, telemedicine does not replace in-person visits and should be discussed on a case-by-case basis.
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Rohde JA, Barker JO, Noar SM. Impact of eHealth technologies on patient outcomes: a meta-analysis of chronic gastrointestinal illness interventions. Transl Behav Med 2021; 11:1-10. [PMID: 31731292 DOI: 10.1093/tbm/ibz166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gastrointestinal (GI) illness interventions are increasingly utilizing eHealth technologies, yet little is currently known about the extent of their impact on patient outcomes. The purpose of this study was to conduct a meta-analysis of the GI eHealth intervention literature. We used a comprehensive search strategy to locate studies. To be included, studies had to be a randomized controlled trial comparing an eHealth intervention condition against a no-treatment or waitlist control condition. Studies had to report data on at least one of the following patient outcomes: medication adherence, quality of life (QoL), psychological distress, illness-related knowledge, or number of patient visits to the clinic/hospital. Analyses weighted effect sizes (d) by their inverse variance and combined them using random effects meta-analytic procedures. K = 19 studies conducted in eight countries with a cumulative sample size of N = 3,193 were meta-analyzed. Findings indicated that GI eHealth interventions improved patients' QoL (d = .25, p = .008), psychological distress (d = .24, p = .017), medication adherence (d = .17, p = .014), and illness-related knowledge (d = .19, p = .002). GI eHealth interventions also significantly reduced the number of patient visits to the clinic/hospital (d = .78, p = .005). Our findings suggest that eHealth interventions hold promise in improving patient outcomes for those with GI illnesses. We suggest the next generation of GI interventions continue developing and evaluating the impact of technology using randomized controlled trial designs, and perhaps consider adapting existing efficacious interventions for burgeoning platforms, such as smartphones and tablets.
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Affiliation(s)
- Jacob A Rohde
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua O Barker
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Navarro-Correal E, Borruel N, Robles V, Herrera-de Guise C, Mayorga Ayala LF, Pérez Martínez Z, Ibarz Casas A, Agustino Rodríguez S, Batuecas Duelt IJ, García Alcaide J, López Branchadell S, Zuriguel-Perez E, Casellas F. Impact of the COVID-19 pandemic on the activity of advanced-practice nurses on a reference unit for inflammatory bowel disease. GASTROENTEROLOGÍA Y HEPATOLOGÍA (ENGLISH EDITION) 2021. [PMCID: PMC8352348 DOI: 10.1016/j.gastre.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To report the impact of the COVID-19 pandemic on the activity of nurses working on an inflammatory bowel disease (IBD) unit and to identify reasons for telehealth care and its relationship to certain characteristics. Background The COVID-19 pandemic had led to an increase in demand for remote care in patients with inflammatory bowel disease who require monitoring and frequent access to health services. Design – methods A retrospective study of all activity (in person and by phone call or email) done on the unit during the acute phase of the pandemic at a reference hospital in Spain. Numbers of activities done by nurses, reasons for telehealth care and sociodemographic and clinical data were collected. Statistical analysis was performed using frequency, chi-squared and analysis of variance tests. Results A total of 1095 activities for 561 patients who received care were reported. Among them, 1042 (95.2%) were telemedicine activities, amounting to a 47.3% increase over the prior year. COVID-19-related activities numbered 588 (59.5%). Consultations due to disease flare-up numbered 134 (13.7%), representing a 145% increase compared to 2019. Significant differences were found between reasons for using telemedicine and diagnosis, occupational status, contact week and treatment. Conclusion The acute phase of the pandemic has changed the activity managed by the nursing staff on the unit. Identifying and analysing these changes has yielded valuable information to achieve more efficient management and better care quality for patients in special situations.
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12
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Volpato E, Bosio C, Previtali E, Leone S, Armuzzi A, Pagnini F, Graffigna G. The evolution of IBD perceived engagement and care needs across the life-cycle: a scoping review. BMC Gastroenterol 2021; 21:293. [PMID: 34261434 PMCID: PMC8278693 DOI: 10.1186/s12876-021-01850-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The chronic and progressive evolution of Inflammatory Bowel Diseases (IBD), with its prototypical fluctuating trend, creates a condition of psycho-social discomfort, impacting the quality of life in terms of personal, working, and interpersonal. AIMS In this article, we want to identify the nature and extent of the research evidence on the life experiences, the perceived engagement, the psychological, social care and welfare needs of people affected by IBD across the lifecycle. METHODS Following the approach set out by Arksey and O'Malley and the PRISMA extension for scoping reviews, we conducted a scoping review in March 2019 and closed the review with an update in October 2019. It was performed using electronic databases covering Health and Life Sciences, Social Sciences and Medical Sciences, such as PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, PsycInfo. RESULTS We identified 95 peer-reviewed articles published from 2009 to 2019, that allowed to detection the main needs in children (psychological, need to be accepted, physical activity, feeding, parent style, support, social needs), adolescents (to understand, physical and psychological needs, protection, relational, gratitude, respect, and engagement) and adults (information, medical, psychological, social, work-related, practical, future-related, engagement). Although the literature confirms that the majority of the IBD units have planned provision for the different types of transitions, the quality and appropriateness of these services have not been assessed or audited for all the kinds of challenges across the life cycle. CONCLUSIONS The literature shows the relevance of organizing a flexible, personalized health care process across all the critical phases of the life cycle, providing adequate benchmarks for comparison in a multidisciplinary perspective and ensuring continuity between hospital and territory.
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Affiliation(s)
- E Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
| | - C Bosio
- EngageMinds Hub Consumer, Food and Health Research Center, Università Cattolica del Sacro Cuore, Milan, Cremona, Italy
| | - E Previtali
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - A Armuzzi
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy
- IRCCS Policlinico Gemelli, Rome, Italy
| | - F Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - G Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy
- EngageMinds Hub Consumer, Food and Health Research Center, Università Cattolica del Sacro Cuore, Milan, Cremona, Italy
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13
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Michel HK, Maltz RM, Boyle B, Donegan A, Dotson JL. Applying Telemedicine to Multidisciplinary Pediatric Inflammatory Bowel Disease Care. CHILDREN-BASEL 2021; 8:children8050315. [PMID: 33919417 PMCID: PMC8143311 DOI: 10.3390/children8050315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 12/13/2022]
Abstract
Multidisciplinary care is essential to the delivery of comprehensive, whole-person care for children and adolescents with inflammatory bowel disease (IBD). Team members may include medical, psychosocial, and ancillary providers as well as patient and family advocates. There is significant variability in how this care is delivered from center to center, though prior to the COVID-19 pandemic, most care occurred during in-person visits. At the onset of the pandemic, medical systems world-wide were challenged to continue delivering high quality, comprehensive care, requiring many centers to turn to telemedicine technology. The aim of this manuscript is to describe the process by which we converted our multidisciplinary pediatric and adolescent IBD visits to a telemedicine model by leveraging technology, a multidisciplinary team, and quality improvement (QI) methods. Finally, we put our experience into context by summarizing the literature on telemedicine in IBD care, with a focus on pediatrics and multidisciplinary care.
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Affiliation(s)
- Hilary K. Michel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Correspondence:
| | - Ross M. Maltz
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for Microbial Pathogenesis, The Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Brendan Boyle
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Amy Donegan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jennifer L. Dotson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; (R.M.M.); (B.B.); (A.D.); (J.L.D.)
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for Innovation in Pediatric Practice, Nationwide Children’s Hospital, Columbus, OH 43205, USA
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14
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Arrigo S, Alvisi P, Banzato C, Bramuzzo M, Celano R, Civitelli F, D'Arcangelo G, Dilillo A, Dipasquale V, Felici E, Fuoti M, Gatti S, Knafelz D, Lionetti P, Mario F, Marseglia A, Martelossi S, Moretti C, Norsa L, Panceri R, Renzo S, Romano C, Romeo E, Strisciuglio C, Martinelli M. Impact of COVID-19 pandemic on the management of paediatric inflammatory bowel disease: An Italian multicentre study on behalf of the SIGENP IBD Group. Dig Liver Dis 2021; 53:283-288. [PMID: 33388247 PMCID: PMC7832380 DOI: 10.1016/j.dld.2020.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND IBD management has been significantly affected during the COVID-19 lockdown with potential clinical issues. AIMS The aim of this study was to analyse the impact of COVID-19 pandemic on the Italian paediatric IBD cohort. METHODS This was a multicentre, retrospective, cohort investigation including 21 different Italian IBD referral centres. An electronic data collection was performed among the participating centres including: clinical characteristics of IBD patients, number of COVID-19 cases and clinical outcomes, disease management during the lockdown and the previous 9 weeks. RESULTS 2291 children affected by IBD were enrolled. We experienced a significant reduction of the hospital admissions [604/2291 (26.3%) vs 1281/2291 (55.9%); p < 0.001]. More specifically, we observed a reduction of hospitalizations for new diagnosis (from n = 44 to n = 27) and endoscopic re-evaluations (from n = 46 to n = 8). Hospitalization for relapses and surgical procedures remained substantially unchanged. Biologic infusions did not significantly vary [393/2291 (17.1%) vs 368/2291 (16%); p = 0.3]. Telemedicine services for children with IBD were activated in 52.3% of the centres. In 42/2291(1.8%) children immunosuppressive therapies were adapted due to the concurrent COVID-19 pandemic. CONCLUSION Due to the several limitations of the lockdown, cares for children with IBD have been kept to minimal standards, giving priorities to the urgencies and to biologics' infusions and implementing telemedicine services.
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Affiliation(s)
- Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute 'Giannina Gaslini', Genoa, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
| | - Claudia Banzato
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Matteo Bramuzzo
- Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy
| | - Rosaria Celano
- Fondazione IRCCS Ca' Grande, Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, Milan, Italy
| | - Fortunata Civitelli
- Department of Gender diseases, Child and Adolescent health, Pediatric unit, Sant'Eugenio Hospital, Rome, Italy
| | - Giulia D'Arcangelo
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Anna Dilillo
- Pediatric and Neonatology Unit, Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Valeria Dipasquale
- Paediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adult and Developmental Age ``Gaetano Barresi'', University of Messina, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Maurizio Fuoti
- Pediatric Gastroenterology and GI Endoscopy, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Italy
| | - Simona Gatti
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
| | - Daniela Knafelz
- Hepatology and Gastroenterology Unit, Bambino Gesù Hospital, Rome, Italy
| | | | | | - Antonio Marseglia
- Fondazione IRCCS Casa Sollievo della Sofferenza, Division of Pediatrics, San Giovanni Rotondo, Italy
| | | | - Chiara Moretti
- Paediatrics Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Norsa
- Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberto Panceri
- Department of Pediatrics, University of Milano-Bicocca, Foundation MBBM/San Gerardo Hospital, Monza, Italy
| | - Sara Renzo
- University of Florence-Meyer Hospital, Florence, Italy
| | - Claudio Romano
- Paediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adult and Developmental Age ``Gaetano Barresi'', University of Messina, Italy
| | - Erminia Romeo
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania ``Luigi Vanvitelli'', Naples, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Italy.
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Lahat A, Shatz Z. Telemedicine in clinical gastroenterology practice: what do patients prefer? Therap Adv Gastroenterol 2021; 14:1756284821989178. [PMID: 33633797 PMCID: PMC7887676 DOI: 10.1177/1756284821989178] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 pandemic has forced major changes on healthcare systems. Maintaining regular patients' surveillance became a major challenge. Telemedicine has been promoted as an economic and effective way for long distance patient care. Our aim was to study patients' acceptance and perspectives on telemedicine. METHODS Patients scheduled for clinic appointments were offered telemedicine. Those who agreed were asked to fill in a questionnaire assessing their satisfaction with the medical consultation. Patients' demographic characteristics and answers were collected and reviewed. RESULTS Out of 358 patients approached 71 agreed to use telemedicine. Of them, 59 completed the questionnaire and were included in the study. All patients' basic demographic data were collected. Patients' included in the study mean age was: 43 ± 16.3 years, 35 (59.3%) women. Patients who chose not to use telemedicine were significantly older, mean age: 61 ± 15.2 years (p = 0.036), 134 (46.7%) women. Most patients included (38; 64.4%) had inflammatory bowel disease (IBD). Most patients who chose not to use telemedicine were non-IBD patients (206, 72%). Fifty-one patients (86.4%) assessed their experience as 'good' or 'excellent'. Satisfied patients had significantly less time under medical follow-up (3.7 versus 6.1 years, p = 0.028) and tended to be younger (p = non-significant). Women were statistically significantly more satisfied than men (33 versus 18, p = 0.05). Advantages reported were 'time saving' (31.3%), accessibility (26.1%), availability (25%). The main disadvantage was absence of physical examination (70%). CONCLUSIONS Telemedicine gained a high satisfaction rate among patients under regular medical surveillance. Most patients stated this that method is convenient, time saving and increases their compliance. Patients who agreed to telecare were younger, and tended to be of female gender and experiencing IBD. Further studies are needed to characterize specific barriers to telecare usage.
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Affiliation(s)
- Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, 52621, Israel
| | - Zina Shatz
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Israel
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16
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Arrigo S, Alvisi P, Banzato C, Bramuzzo M, Civitelli F, Corsello A, D'Arcangelo G, Dilillo A, Dipasquale V, Felici E, Fuoti M, Gatti S, Giusti Z, Knafelz D, Lionetti P, Mario F, Marseglia A, Martelossi S, Moretti C, Norsa L, Nuti F, Panceri R, Rampado S, Renzo S, Romano C, Romeo E, Strisciuglio C, Martinelli M. Management of paediatric IBD after the peak of COVID-19 pandemic in Italy: A position paper on behalf of the SIGENP IBD working group. Dig Liver Dis 2021; 53:183-189. [PMID: 33132063 PMCID: PMC7580561 DOI: 10.1016/j.dld.2020.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022]
Abstract
Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2, spreading in Italy during the first months of 2020, abruptly changed the way of practicing medicine in this country. As a consequence of the lockdown, the diagnostic and therapeutic management of paediatric chronic conditions, such as inflammatory bowel disease (IBD) has been affected. During the peak of COVID-19 pandemic, elective visits, endoscopies and infusions have been postponed, with potential clinical and psychological impact on disease course and a high likelihood of increasing waiting lists. While slowly moving back towards normality, clinicians need to recognize the best ways to care for patients with IBD, carefully avoiding risk factors for new potential epidemic outbreaks. In this uncertain scenario until the development and spread of COVID-19 vaccine, it is necessary to continue to operate with caution. Hereby we provide useful indications for a safer and gradual restarting of routine clinical activities after COVID-19 peak in Italy.
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Affiliation(s)
- Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute 'Giannina Gaslini', Genoa, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
| | - Claudia Banzato
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Matteo Bramuzzo
- Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy
| | - Fortunata Civitelli
- Department of Gender diseases, Child and Adolescent health, Pediatric unit, Sant'Eugenio Hospital, Rome, Italy
| | - Antonio Corsello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, OU Internal Medicine and Gastroenterology, Rome, Italy
| | - Giulia D'Arcangelo
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Anna Dilillo
- Pediatric and Neonatology Unit, Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Valeria Dipasquale
- Paediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Maurizio Fuoti
- Pediatric Gastroenterology and GI Endoscopy, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Italy
| | - Simona Gatti
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
| | - Zeno Giusti
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", , Via S. Pansini, 5, 80131 Naples, Italy
| | - Daniela Knafelz
- Hepatology and Gastroenterology Unit, Bambino Gesù Hospital, Rome, Italy
| | | | | | - Antonio Marseglia
- Fondazione IRCCS Casa Sollievo della Sofferenza, Division of Pediatrics, San Giovanni Rotondo, Italy
| | | | - Chiara Moretti
- Paediatrics Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Norsa
- Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federica Nuti
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, Milan, Italy
| | - Roberto Panceri
- Department of Pediatrics, University of Milano-Bicocca, Foundation MBBM/San Gerardo Hospital, Monza, Italy
| | | | - Sara Renzo
- University of Florence-Meyer Hospital, Florence, Italy
| | - Claudio Romano
- Paediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Italy
| | - Erminia Romeo
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", , Via S. Pansini, 5, 80131 Naples, Italy.
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Impact of the COVID-19 pandemic on the activity of advanced-practice nurses on a reference unit for inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:481-488. [PMID: 33515625 PMCID: PMC7839383 DOI: 10.1016/j.gastrohep.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 01/23/2023]
Abstract
Objective To report the impact of the COVID-19 pandemic on the activity of nurses working on an inflammatory bowel disease (IBD) unit and to identify reasons for telehealth care and its relationship to certain characteristics. Background The COVID-19 pandemic had led to an increase in demand for remote care in patients with inflammatory bowel disease who require monitoring and frequent access to health services. Design – methods A retrospective study of all activity (in person and by phone call or email) done on the unit during the acute phase of the pandemic at a reference hospital in Spain. Numbers of activities done by nurses, reasons for telehealth care and sociodemographic and clinical data were collected. Statistical analysis was performed using frequency, chi-squared and analysis of variance tests. Results A total of 1095 activities for 561 patients who received care were reported. Among them, 1042 (95.2%) were telemedicine activities, amounting to a 47.3% increase over the prior year. COVID-19-related activities numbered 588 (59.5%). Consultations due to disease flare-up numbered 134 (13.7%), representing a 145% increase compared to 2019. Significant differences were found between reasons for using telemedicine and diagnosis, occupational status, contact week and treatment. Conclusion The acute phase of the pandemic has changed the activity managed by the nursing staff on the unit. Identifying and analysing these changes has yielded valuable information to achieve more efficient management and better care quality for patients in special situations.
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Östlund I, Werner M, Karling P. Self-monitoring with home based fecal calprotectin is associated with increased medical treatment. A randomized controlled trial on patients with inflammatory bowel disease. Scand J Gastroenterol 2021; 56:38-45. [PMID: 33284639 DOI: 10.1080/00365521.2020.1854342] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Self-monitoring of inflammatory bowel disease (IBD) with the assistant of telemedicine and home-based fecal calprotectin (FC) tests is evolving in the management of IBD. We performed a randomized controlled trial to investigate the compliance and effects of the model IBD-Home in patients with IBD. MATERIALS AND METHODS Patients were randomized to IBD-Home + standard care (n = 84) or standard care alone (n = 74). Intervention with IBD-Home included IBDoc® FC test kits and a digital application used for answering symptom questionnaires (Abbvie/Telia). They were instructed to use these on demand during a 12-month period. Data was collected retrospectively from medical records. Patients who completed the intervention were phoned and asked to answer a survey about the experience of IBD-Home. RESULTS The compliance to IBD-Home was low (29%). Women were more compliant compared with men (43% vs 17%, p < .001). A significantly higher proportion of patients in the IBD-Home group increased their medical treatment during the study period in comparison to control subjects (33% vs 15% p = .007) and there was an association between an increase in treatment and compliance to IBD home (multivariate odds ratio 3.22; 95th confidence interval 1.04 - 9.95). Overall patients reported a positive experience with slight technical difficulties. CONCLUSION Self-monitoring with home based fecal calprotectin and a digital application was found feasible and appreciated by compliers. Compliance to the IBD-Home model was more common in women and associated with an increased treatment for IBD.
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Affiliation(s)
- Isak Östlund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mårten Werner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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19
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Richard L, Noller G, Derrett S, Sullivan T, Doolan-Noble F, McCombie A, Schultz M, Ho C, Stokes T. Patients' accounts of living with and managing inflammatory bowel disease in rural Southern New Zealand: a qualitative study. BMJ Open 2020; 10:e041789. [PMID: 33184085 PMCID: PMC7662529 DOI: 10.1136/bmjopen-2020-041789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To explore how adults living with inflammatory bowel disease (IBD) in rural New Zealand manage their condition and engage with healthcare providers. DESIGN Qualitative exploratory design with semi-structured interviews analysed thematically. SETTING AND PARTICIPANTS Interviews were conducted with 18 people living with IBD in the Otago region of the South Island. RESULTS Five important constructs were identified: (1) journey to confirming and accepting diagnosis; (2) importance of the relationship with the healthcare team; (3) support from others; (4) learning how to manage IBD and (5) care at a distance-experiences of rurality. Pathways to confirming diagnosis involved two contrasting journeys: a long and slow process where diagnosis remained unclear for a prolonged period, and a more acute process where diagnosis typically came as a shock. Central to the acceptance process was acknowledging the chronicity of the condition, which involved feelings of grief but also the fear of judgement and stigma. Building a strong relationship with the specialist was central to medical management, particularly in the initial stage following diagnosis. Support from others was critical, enabling participants to progress through acceptance of the disease and developing confidence in its everyday management. Participants shared different strategies on how to manage IBD, describing a 'trial and error' process of 'finding what is right' at different stages of the condition. Managing IBD rurally involved challenges of access to specialist care, with perceptions of delayed referrals and concerns about disparities in specialist access compared with urban counterparts. Rural living also had financial implications-cost of time and cost of mobilising resources for long travels to the urban centre for treatments. CONCLUSIONS Findings from this study provide a rich understanding of the complex health journeys of people living with IBD and the challenges of managing the condition rurally.
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Affiliation(s)
- Lauralie Richard
- Department of General Practice & Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Geoff Noller
- Department of General Practice & Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive & Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Department of Preventive & Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Fiona Doolan-Noble
- Department of General Practice & Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Andrew McCombie
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Michael Schultz
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
- Department of Gastroenterology, Southern District Health Board, Dunedin, New Zealand
| | - Christine Ho
- Department of Gastroenterology, Southern District Health Board, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice & Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
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Ribaldone DG, Astegiano M, Actis GC, Pellicano R. Management of inflammatory bowel disease during COVID-19 pandemic. MINERVA GASTROENTERO 2020; 66:184-186. [PMID: 32327626 DOI: 10.23736/s1121-421x.20.02707-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Davide G Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Marco Astegiano
- Unit of Gastroenterology, Molinette-SGAS Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette-SGAS Hospital, Città della Salute e della Scienza, Turin, Italy
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21
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Zand A, Nguyen A, Stokes Z, van Deen W, Lightner A, Platt A, Jacobs R, Reardon S, Kane E, Sack J, Hommes D. Patient Experiences and Outcomes of a Telehealth Clinical Care Pathway for Postoperative Inflammatory Bowel Disease Patients. Telemed J E Health 2020; 26:889-897. [DOI: 10.1089/tmj.2019.0102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Aria Zand
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Leiden University Medical Center, Department of Digestive Diseases, Leiden, The Netherlands
| | - Audrey Nguyen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Zack Stokes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Welmoed van Deen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amy Lightner
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anya Platt
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Rutger Jacobs
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Sarah Reardon
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
| | - Ellen Kane
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Jonathan Sack
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
| | - Daniel Hommes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Leiden University Medical Center, Department of Digestive Diseases, Leiden, The Netherlands
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Abstract
PURPOSE OF REVIEW In the context of the rising incidence and complexity of inflammatory bowel disease (IBD), telehealth offers new ways to support remote and efficient delivery of healthcare services. The aim of this review is to assess the current status of telehealth services in the management of IBD and challenges to adopting telehealth in clinical practice. RECENT FINDINGS Different modalities of telehealth such as virtual clinics and remote patient monitoring have been studied in many IBD centers. They are found to be associated with high patient acceptance, decreased healthcare costs, improved quality of life, treatment adherence, and disease knowledge among patients. The major challenges encountered in the integration of telemedicine into clinical practice include risks to patient privacy and confidentiality, requirement for informed consent, lack of uniform reimbursement policies, operational difficulties, provider acceptance, and licensing. SUMMARY Telehealth is an effective, efficient, and low-cost intervention that can address increasingly complex care of patients with IBD. However, for telemedicine to be adopted widely, new policies and reforms need to reduce the burden of physician licensing in multiple states, allow for receipt of all telehealth services in the patient's home or office, and require reimbursement for services on par with an office visit.
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23
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COVID-19-A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist. J Pediatr Gastroenterol Nutr 2020; 70:734-740. [PMID: 32443021 PMCID: PMC7273955 DOI: 10.1097/mpg.0000000000002749] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Rosenblatt R, Yeh J, Gaglio PJ. Long-Term Management: Modern Measures to Prevent Readmission in Patients with Hepatic Encephalopathy. Clin Liver Dis 2020; 24:277-290. [PMID: 32245533 DOI: 10.1016/j.cld.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hepatic encephalopathy (HE) is a frequent indication for hospitalization and represents a common manifestation of portal hypertension and decompensated liver disease that contributes to hospital readmissions. Multiple new techniques are being evaluated to assist in preventing readmissions in these high-risk patients. Techniques to improve medication adherence are paramount. The use of telemedicine and on-demand patient assessment is likely to diminish hospitalizations for HE. Wearable technology has the potential to assist in HE diagnosis and prevent HE progression, with an anticipated diminution in hospital readmissions. This article discusses current and potential future techniques to improve outcomes in these vulnerable patients.
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Affiliation(s)
- Russell Rosenblatt
- Department of Medicine, Center for Liver Disease and Transplantation, NY-Presbyterian Hospital, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, PH-14 622 West 168th Street, New York, NY 10032, USA
| | - Johnathan Yeh
- Department of Medicine, Center for Liver Disease and Transplantation, NY-Presbyterian Hospital, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, PH-14 622 West 168th Street, New York, NY 10032, USA
| | - Paul J Gaglio
- Department of Medicine, Center for Liver Disease and Transplantation, NY-Presbyterian Hospital, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, PH-14 622 West 168th Street, New York, NY 10032, USA.
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25
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Adaptation of TECCU App Based on Patients´ Perceptions for the Telemonitoring of Inflammatory Bowel Disease: A Qualitative Study Using Focus Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061871. [PMID: 32183103 PMCID: PMC7143635 DOI: 10.3390/ijerph17061871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 01/18/2023]
Abstract
Background: Despite the continuous adaptation of eHealth systems for patients with inflammatory bowel disease (IBD), a significant disconnection persists between users and developers. Since non-adherence remains high, it is necessary to better understand the patients’ perspective on telemonitoring for IBD. Accordingly, this study aimed to adapt the TECCU telemonitoring app to the preferences and needs of IBD patients. Methods: A qualitative study was carried out using successive focus groups of IBD patients. Meetings were audio-recorded and a thematic analysis was employed until data saturation was achieved. The first group included patients who had used the TECCU App in a pilot clinical trial, and subsequent meetings included patients with Crohn’s disease and ulcerative colitis recruited from the Spanish Confederation of patient associations. The information collected at each meeting guided consecutive changes to the platform. Results: Data saturation was reached after three focus groups involving a total of 18 patients. Three main themes emerged: (1) platform usability, (2) the communication process, and (3) platform content. All participants indicated that TECCU is easy to use, permitting continuous and personalized feedback. According to patients´ perspectives, the platform was adapted to foster a flexible follow-up and shared decision-making using open and safe communication networks. Many participants appreciated the educational elements and, consequently, the app was connected to reliable and continuously updated webpages. Conclusions: IBD patients valued the usability and personalized monitoring offered by the TECCU App. Improvements in the messaging system and continuously updated educational content were introduced to address patients´ needs and favor their engagement.
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26
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Abstract
PURPOSE OF REVIEW Telehealth is the delivery of health care using the most recent technological advances. With the growing complexity of inflammatory bowel disease (IBD) care, telehealth allows for delivery of specialty services to an extended population. We reviewed the most recent literature on telehealth modalities, including patient-reported and disease outcomes associated with use of telehealth. RECENT FINDINGS Current methods of telemedicine include telehealth, remote patient monitoring, and the use of mobile applications. Remote patient monitoring via web applications has been studied with improvement in patient-reported quality of life, medication adherence, and decreased heath care costs. Mobile applications can be used for symptom reporting and alert the medical team if a patient is reporting increased symptoms. These web and mobile applications allow for treatment decisions to occur without the delay of an office visit. There remain limitations to telehealth including technological concerns, physician acceptance, and licensing and reimbursement inequities. Telemedicine is a safe, effective, and accepted method of meeting the growing demand for complex IBD care throughout the world. The use of telehealth video conference and remote patient monitoring with web-based applications and text messaging has been shown to ease financial burdens of chronic disease, improve patient quality of life, and lead to improved clinical outcomes.
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Affiliation(s)
- Lauren A George
- University of Maryland School of Medicine, 685 W. Baltimore St., Suite 8-00, Baltimore, MD, 21201, USA
| | - Raymond K Cross
- University of Maryland School of Medicine, 685 W. Baltimore St., Suite 8-00, Baltimore, MD, 21201, USA.
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27
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Del Hoyo J, Nos P, Bastida G, Faubel R, Muñoz D, Garrido-Marín A, Valero-Pérez E, Bejar-Serrano S, Aguas M. Telemonitoring of Crohn's Disease and Ulcerative Colitis (TECCU): Cost-Effectiveness Analysis. J Med Internet Res 2019; 21:e15505. [PMID: 31538948 PMCID: PMC6754696 DOI: 10.2196/15505] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although electronic health interventions are considered safe and efficient, evidence regarding the cost-effectiveness of telemonitoring in inflammatory bowel disease is lacking. OBJECTIVE We aimed to evaluate the cost-effectiveness and cost-utility of the Telemonitorización de la Enfermedad de Crohn y Colitis Ulcerosa (Telemonitoring of Crohn's Disease and Ulcerative Colitis [TECCU]) Web platform (G_TECCU intervention group) for telemonitoring complex inflammatory bowel disease, compared with standard care (G_control) and nurse-assisted telephone care (G_NT intervention group). METHODS We analyzed cost-effectiveness from a societal perspective by comparing the 3 follow-up methods used in a previous 24-week randomized controlled trial, conducted at a tertiary university hospital in Spain. Patients with inflammatory bowel disease who initiated immunosuppressants or biologic agents, or both, to control inflammatory activity were recruited consecutively. Data on the effects on disease activity (using clinical indexes) and quality-adjusted life-years (using the EuroQol 5 dimensions questionnaire) were collected. We calculated the costs of health care, equipment, and patients' productivity and social activity impairment. We compared the mean costs per patient, utilities, and bootstrapped differences. RESULTS We included 63 patients (21 patients per group). TECCU saved €1005 (US $1100) per additional patient in remission compared with G_control (95% CI €-13,518 to 3137; US $-14,798 to 3434), with a 79.96% probability of being more effective at lower costs. Compared with G_NT, TECCU saved €2250 (US $2463) per additional patient in remission (95% CI €-15,363 to 11,086; US $-16,817 to 12,135), and G_NT saved €538 (US $589) compared with G_control (95% CI €-6475 to 5303; US $-7088 to 5805). G_TECCU and G_NT showed an 84% and 67% probability, respectively, of producing a cost saving per additional quality-adjusted life-year (QALY) compared with G_control, considering those simulations that involved negative incremental QALYs as well. CONCLUSIONS There is a high probability that the TECCU Web platform is more cost-effective than standard and telephone care in the short term. Further research considering larger cohorts and longer time horizons is required. TRIAL REGISTRATION ClinicalTrials.gov NCT02943538; https://clinicaltrials.gov/ct2/show/NCT02943538 (http://www. webcitation.org/746CRRtDN).
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Affiliation(s)
- Javier Del Hoyo
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Networked Biomedical Research Center for Hepatic and Digestive Diseases, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Guillermo Bastida
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Networked Biomedical Research Center for Hepatic and Digestive Diseases, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Raquel Faubel
- Physiotherapy Department, University of Valencia, Valencia, Spain
- Joint Research Unit in Biomedical Engineering-eRPSS, Health Research Institute La Fe-Polytechnic University of Valencia, Valencia, Spain
| | - Diana Muñoz
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Elena Valero-Pérez
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Sergio Bejar-Serrano
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Mariam Aguas
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Networked Biomedical Research Center for Hepatic and Digestive Diseases, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
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28
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Sebastian S, Roberts J, Waller J, Judge D, Brown C, Davies R, Kachroo S. Remote Monitoring of Patient-Reported Outcomes in Ulcerative Colitis: A Prospective Real-World Pilot Study. PHARMACOECONOMICS - OPEN 2019; 3:359-365. [PMID: 30900117 PMCID: PMC6710315 DOI: 10.1007/s41669-019-0121-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION The 6-point version of the Mayo score relies on two patient-reported outcomes (PRO2): stool frequency and rectal bleeding. We assessed the feasibility and acceptability of remote online PRO2 reporting for golimumab-treated ulcerative colitis (UC) patients. PATIENTS AND METHODS This was a UK-based, multi-centre, prospective, real-world, non-interventional pilot study. Eligible patients completed PRO2 scores at baseline and every 4 weeks over a period of 6 months. Demographics were collected at baseline and a satisfaction questionnaire was completed at study end. Each patient provided data anonymously via an online platform. RESULTS Fifty-two patients enrolled in the study. Mean (SD) patient age was 40.8 (13.6); 52% were male. Patients provided data on a personal computer (44%), mobile phone (38%) or tablet (18%). Forty-seven (90%) patients completed the baseline questionnaire within the accepted time range. Subsequent scores were reported on time by eligible patients with a success rate of 94%, 92%, 90%, 87%, 90% and 81% at end of months 1-6, respectively. CONCLUSIONS Remote monitoring of PRO2 in UC was feasible amongst the sample tested. Of those initially willing to provide data in this way, attrition was low. Formal roll-out of this system could be used to support a more frequent assessment of UC symptoms without over-burdening the healthcare system.
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Affiliation(s)
- Shaji Sebastian
- IBD Unit, Hull and East Yorkshire Hospital NHS Trust, Hull, UK
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29
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Quinn KP, Prothero BL, Russell JM, Hegge RJ, von Bormann AG, Larson PA, Christofferson SN, Smyrk TC, Mathis KL, Goenka AH, Sheedy SP, Bruining DH, Fletcher JG, Loftus EV, Raffals LE. Impact of a Multidisciplinary eBoard on the Management of Patients With Complex Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2019. [DOI: 10.1093/crocol/otz013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
We aim to assess the impact of a multidisciplinary inflammatory bowel disease (IBD) conference on the management of patients with complex IBD.
Methods
Data were collected during each conference from February 2017 through October 2018 with chart review performed at 6 months to determine if conference recommendations were successfully implemented.
Results
Eighty-five patients were discussed. The presenting diagnosis was changed by 11.8%. Recommendations for further testing, medical therapy, and surgery were successfully implemented in 77.1%, 98.1%, and 88.4%, respectively.
Conclusions
This study supports the role of IBD multidisciplinary conferences in the management of patients with complex IBD.
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Affiliation(s)
- Kevin P Quinn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | | | - Ryan J Hegge
- Media Support Services, Mayo Clinic, Rochester, MN
| | | | | | | | - Thomas C Smyrk
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
| | | | | | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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30
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Ruf B, Jenkinson P, Armour D, Fraser M, Watson AJ. Videoconference clinics improve efficiency of inflammatory bowel disease care in a remote and rural setting. J Telemed Telecare 2019; 26:545-551. [PMID: 31167590 DOI: 10.1177/1357633x19849280] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Patients with inflammatory bowel disease (IBD) require long-term secondary care with periodic specialist follow-up. This can be especially challenging for patients living in remote areas. One possible solution is the implementation of videoconference (VC) clinics as a distance-management tool. Here we assessed the use of VC clinics for IBD in terms of patient safety and economic benefit for patients with IBD living in rural areas in the Scottish Highlands and Islands. METHODS Eighty-eight patients participating in the IBD specialist nurses VC clinic administered via Raigmore Hospital, Inverness, Scotland, UK, between January 2016 and June 2017 were included in this study. A total of 229 appointments were assessed. RESULTS We found the use of a VC clinic to be safe and effective as only 0.9% of appointments required urgent medical assessment and 92% of the VC clinic appointments resulted in further VC clinic follow-up. A total travelling distance of 72,245.3 km and a total travelling time of 71,688 minutes were saved in this patient cohort. It was shown that an average of US$36.61 of potential travelling cost could be saved per appointment. DISCUSSION VC clinics represent a patient-centred participatory model of care for IBD patients living in remote areas with enormous time- and cost-saving potential while being safe and effective. Further investigations into patient satisfaction and the combination with other telemedicine tools such as telephone conferencing and mobile phone applications are needed to evaluate the full potential of the concept.
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Affiliation(s)
- Benjamin Ruf
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Tübingen, Germany
| | - Phillip Jenkinson
- Colorectal Surgery, Department of Surgery, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - David Armour
- Liver and Gastroenterology Service, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - Mhairi Fraser
- Liver and Gastroenterology Service, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - Angus Jm Watson
- Colorectal Surgery, Department of Surgery, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
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31
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Haisma SM, Galaurchi A, Almahwzi S, Adekanmi Balogun JA, Muller Kobold AC, van Rheenen PF. Head-to-head comparison of three stool calprotectin tests for home use. PLoS One 2019; 14:e0214751. [PMID: 30998692 PMCID: PMC6472756 DOI: 10.1371/journal.pone.0214751] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/19/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Treatment decisions in inflammatory bowel diseases are increasingly based on longitudinal tracking of calprotectin results. Many hospital laboratories measure calprotectin levels in sent-in stool samples with an enzyme-linked immunosorbent assay (ELISA). Several manufacturers introduced a lateral flow-based test with software application that turns a smartphone camera into a reader for quantitative measurements. We compared three home tests (IBDoc, QuantonCal and CalproSmart) and companion ELISA tests (fCAL, IDK-Calprotectin and Calprotectin-ALP) to see if measurement pairs agreed sufficiently. DESIGN A method comparison study was conducted with stool samples from patients with active or quiescent inflammatory bowel disease. Medical students without any specific laboratory training carried out the home tests with two iOS (iPhone 6 and 7) and two Android devices (Samsung Galaxy S6 and Motorola Moto G5 Plus). Two experienced laboratory technicians measured the calprotectin concentration with the ELISA method. Primary outcome was test agreement (defined as percentage of paired measurements within predefined limits of difference). Secondary outcome included reading error rate (RER) per smartphone type. RESULTS We performed 1440 smartphone readings and 120 ELISA tests. In the low calprotectin range (≤500 μg/g) IBDoc, QuantOnCal and CalproSmart showed 87%, 82% and 76% agreement with their companion ELISAs. In the high range (>500 μg/g) the agreement was 37%, 19% and 37%, respectively. CalproSmart and QuantOnCal had significantly higher RERs than IBDoc (respectively 5.8% and 4.8%, versus 1.9%). Forty-three percent of reading errors was on the Motorola device, in particular with the QuantOnCal application. CONCLUSIONS All three calprotectin home tests and companion ELISAs agreed sufficiently when concentrations are ≤500 μg/g. To minimize wrongful interpretation of calprotectin changes over time it is essential to always use the home test and companion ELISA of one and the same manufacturer. Manufacturers should explicitly evaluate and report the suitability of commonly used smartphones for quantitative calprotectin readings.
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Affiliation(s)
- Sjoukje-Marije Haisma
- Department of Paediatric Gastroenterology Hepatology and Nutrition, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Anne Galaurchi
- Department of Paediatric Gastroenterology Hepatology and Nutrition, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Shatha Almahwzi
- Department of Paediatric Gastroenterology Hepatology and Nutrition, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Joy A Adekanmi Balogun
- Department of Paediatric Gastroenterology Hepatology and Nutrition, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology Hepatology and Nutrition, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Parfenov AI, Kagramanova AV, Babayan AF, Knyazev OV. Adherence to therapy of patients with inflammatory bowel diseases. TERAPEVT ARKH 2018; 90:4-11. [PMID: 30701826 DOI: 10.26442/00403660.2018.12.000001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Inflammatory bowel diseases are autoimmune systemic forms of pathology. The concept of continuous life-long drug intake is a cornerstone in their therapy. The review presents the factors that reduce patients adherence to treatment and ways to improve it. They include informing the patient about the disease and treatment, selection of individual therapy regimen, consolidation of achievements, provision of social support and interaction with other specialists.
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Affiliation(s)
- A I Parfenov
- A.S. Loginov Moscow Clinical Scientific Center of the Department of Health of Moscow, Moscow, Russia
| | - A V Kagramanova
- A.S. Loginov Moscow Clinical Scientific Center of the Department of Health of Moscow, Moscow, Russia
| | - A F Babayan
- A.S. Loginov Moscow Clinical Scientific Center of the Department of Health of Moscow, Moscow, Russia
| | - O V Knyazev
- A.S. Loginov Moscow Clinical Scientific Center of the Department of Health of Moscow, Moscow, Russia
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Aguas M, Del Hoyo J, Faubel R, Muñoz D, Domínguez D, Bastida G, Navarro B, Barrios A, Valdivieso B, Correcher M, Nos P. A Web-Based Telemanagement System for Patients With Complex Inflammatory Bowel Disease: Protocol for a Randomized Controlled Clinical Trial. JMIR Res Protoc 2018; 7:e190. [PMID: 30578197 PMCID: PMC6320427 DOI: 10.2196/resprot.9639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Telemedicine has been successfully used to provide inflammatory bowel disease (IBD) patients with health care services remotely via the implementation of information and communications technology, which uses safe and feasible apps that have been well accepted by patients in remission. However, the design of telemedicine apps in this setting involves difficulties that hinder the adherence of patients to the follow-up plans and the efficacy of these systems to improve disease activity and quality of life. OBJECTIVE This study aimed to evaluate the development of a Web platform, Telemonitoring of Crohn Disease and Ulcerative Colitis (TECCU), for remote monitoring of patients with complex IBD and the design of a clinical trial involving IBD patients who received standard care (G_Control), nurse-assisted telephone care (G_NT), or care based on distance monitoring (G_TECCU). METHODS We describe the development of a remote monitoring system and the difficulties encountered in designing the platform. A 3-arm randomized controlled trial was designed to evaluate the effectiveness of this Web platform in disease management compared with G_NT and G_Control. RESULTS According to the schedules established for the medical treatment initiated (corticosteroids, immunosuppressants, or biological agents), a total of 63 patients (21 patients from each group) answered periodic questionnaires regarding disease activity, quality of life, therapeutic adherence, adverse effects, satisfaction, work productivity, and social activities. Blood and stool analyses (fecal calprotectin) were performed periodically. On the basis of the results of these tests in G_TECCU, alerts were generated in a Web platform with adapted action plans, including changes in medication and frequency of follow-up. The main issues found were the development of an easy-to-use Web platform, the selection of validated clinical scores and objective biomarkers for remote monitoring, and the design of a clinical trial to compare the 3 main follow-up methods evaluated to date in IBD. CONCLUSIONS The development of a Web-based remote management program for safe and adequate control of IBD proved challenging. The results of this clinical trial will advance knowledge regarding the effectiveness of TECCU Web platform for improvement of disease activity, quality of life, and use of health care resources in complex IBD patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02943538; https://clinicaltrials.gov/ct2/show/NCT02943538 (Archived by WebCite at http://www.webcitation.org/6y4DQdmt8). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/9639.
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Affiliation(s)
- Mariam Aguas
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Diseases), Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Javier Del Hoyo
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Raquel Faubel
- Physiotherapy Department, University of Valencia, Valencia, Spain
- Joint Research Unit in Biomedical Engineering (eRPSS: IIS La Fe-UPV), Valencia, Spain
| | - Diana Muñoz
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Guillermo Bastida
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Diseases), Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Belén Navarro
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Alejandra Barrios
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Bernardo Valdivieso
- Joint Research Unit in Biomedical Engineering (eRPSS: IIS La Fe-UPV), Valencia, Spain
- Home Care and Telemedicine Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Marisa Correcher
- Systems Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Diseases), Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
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Del Hoyo J, Nos P, Faubel R, Muñoz D, Domínguez D, Bastida G, Valdivieso B, Correcher M, Aguas M. A Web-Based Telemanagement System for Improving Disease Activity and Quality of Life in Patients With Complex Inflammatory Bowel Disease: Pilot Randomized Controlled Trial. J Med Internet Res 2018; 20:e11602. [PMID: 30482739 PMCID: PMC6301812 DOI: 10.2196/11602] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/09/2018] [Accepted: 10/22/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The reported efficacy of telemedicine in patients with inflammatory bowel disease (IBD) is inconsistent among studies, and data for complex IBD are lacking. OBJECTIVE We aimed to evaluate the impact of remote monitoring using a Web system-Telemonitorización de la Enfermedad de Crohn y Colitis Ulcerosa or Telemonitoring of Crohn's Disease and Ulcerative Colitis (TECCU)-as compared to standard care and telephone care on health outcomes and health care in patients with complex IBD. METHODS We performed a 3-arm randomized controlled trial. Adult patients with IBD who received immunosuppressants and biological agents were recruited from the IBD Unit of a tertiary university hospital. The patients were randomized into groups to receive remote monitoring (G_TECCU), nurse-assisted telephone care (G_NT), or standard care with in-person visits (G_control). All patients completed the study visits at baseline and at 12 and 24 weeks in addition to each type of intervention. The primary outcome was the percentage of patients in remission at 24 weeks. Secondary health outcomes were quality of life, medication adherence, adverse effects, satisfaction, and social activities. Data on the number of outpatient visits and telephone calls, emergency visits, hospitalizations, IBD-related surgeries, and corticosteroid courses were also collected. RESULTS A total of 63 patients were selected (21 patients in each group). During the study, 90.5% (19/21) of patients in G_control, 95.2% (20/21) in G_NT, and 85.7% (18/21) in G_TECCU were compliant to the intervention. After 24 weeks, the percentage of patients in remission was higher in G_TECCU (17/21, 81%) than in G_NT (14/21, 66.7%) and G_control (15/21, 71.4%). A higher improvement in disease activity was observed in G_TECCU than in G_control in terms of the Harvey-Bradshaw/Mayo (odds ratio=0.12, 95% CI=0.003-2.162, P=.19) and Harvey-Bradshaw/Walmsley (odds ratio=0.11, 95% CI=0.004-1.55, P=.13) indexes. Improvement in disease activity was associated with a larger reduction in fecal calprotectin values in G_TECCU compared to G_control (estimated intervention effect: odds ratio=-0.90; 95% CI=-1.96 to 0.16, P=.11). All completers adhered to treatment in G_TECCU. In addition, the quality of life, social activities, and satisfaction improved in all 3 groups. Although the number of outpatient visits and telephone calls was lower in G_TECCU than in G_NT and G_control, the safety profile was similar in all 3 groups. CONCLUSIONS This pilot clinical trial suggests that the TECCU Web-based system is a safe strategy for improving health outcomes in patients with complex IBD and reducing the use of health care resources. TRIAL REGISTRATION ClinicalTrials.gov NCT02943538; https://clinicaltrials.gov/ct2/show/NCT02943538 (Archived by WebCite at http://www.webcitation.org/746CRRtDN).
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Affiliation(s)
- Javier Del Hoyo
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Diseases), Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Raquel Faubel
- Physiotherapy Department, University of Valencia, Valencia, Spain
- Joint Research Unit in Biomedical Engineering (eRPSS: IIS La Fe-UPV), Valencia, Spain
| | - Diana Muñoz
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Guillermo Bastida
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Diseases), Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Bernardo Valdivieso
- Joint Research Unit in Biomedical Engineering (eRPSS: IIS La Fe-UPV), Valencia, Spain
- Home Care and Telemedicine Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Marisa Correcher
- Systems Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Mariam Aguas
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Diseases), Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
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Kim ES, Lee YJ, Jang BI, Kim KO, Kim EY, Lee HS, Jeon SW, Kwak SG, on behalf of Crohn’s and Colitis Association in Daegu-Gyeongbuk (CCAiD). Disparity in Crohn's disease activity between home and clinics is associated with unscheduled hospital visits due to disease flares. Korean J Intern Med 2018; 33:902-910. [PMID: 29334724 PMCID: PMC6129636 DOI: 10.3904/kjim.2016.387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/02/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS E-health technologies have been implemented for the management of Crohn's disease (CD). We aimed to identify differences between patient activities at home and at routine clinic visits using a web-based self-reporting CD symptom diary (CDSD) and to determine the impact of this disparity on clinical outcomes. METHODS Patients with CD from three tertiary hospitals were invited to assess their symptoms at least once a week using CDSD. We identified patients who showed disparities in disease activity (high activity at home but normal at the next hospital visit) and evaluated clinical outcomes of these patients such as unscheduled visits due to flares using Kaplan-Meier analyses. RESULTS One hundred and forty-three patients recorded their symptoms weekly for at least 3 consecutive months and were included. Forty-eight patients (33.6%) showed disparate disease activities between at home and at the next outpatient clinic visit. The cumulative risk of unscheduled visits was significantly higher in this disparity group than in the concordant group (p = 0.001). Disparity in activity (p = 0.003), and anti-tumor necrosis factor use (p = 0.002) were independent risk factors of unscheduled visits due to disease flares. CONCLUSION Disparity in disease activity is considerable in CD patients and is related to the risk of unscheduled hospital visit.
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Affiliation(s)
- Eun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yoo Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Ik Jang
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
- Correspondence to Byung Ik Jang, M.D. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-250-8096 Fax: +82-53-250-7088 E-mail:
| | - Kyeong Ok Kim
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyun Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seong Woo Jeon
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu, Korea
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Hong SN. Clinical usefulness of remote patient monitoring using e-Health technologies in patients with inflammatory bowel diseases. Korean J Intern Med 2018; 33:876-878. [PMID: 30180515 PMCID: PMC6129642 DOI: 10.3904/kjim.2018.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Sung Noh Hong
- Correspondence to Sung Noh Hong, M.D. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3409 Fax: +82-2-3410-6983 E-mail:
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Ghattamaneni NKR, Panchal SK, Brown L. Nutraceuticals in rodent models as potential treatments for human Inflammatory Bowel Disease. Pharmacol Res 2018; 132:99-107. [PMID: 29680446 DOI: 10.1016/j.phrs.2018.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/26/2018] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
Inflammatory Bowel Disease (IBD) is characterized by chronic inflammation of all or part of the digestive tract. Nutraceuticals include bioactive compounds such as polyphenols with anti-inflammatory activities, thus these products have the potential to treat chronic inflammatory diseases. We have emphasized the role of nutraceuticals in ameliorating the symptoms of IBD in rodent models of human IBD through modulation of key pathogenic mechanisms including dysbiosis, oxidative stress, increased inflammatory cytokines, immune system dysregulation, and inflammatory cell signaling pathways. Nutraceuticals have an important role in IBD patients as a preventive approach to extend remission phases and as a therapeutic intervention to suppress active IBD. Further clinical trials on nutraceuticals with positive results in rodent models are warranted.
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Affiliation(s)
- Naga K R Ghattamaneni
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, QLD 4350, Australia; Functional Foods Research Group, Institute for Agriculture and the Environment, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Sunil K Panchal
- Functional Foods Research Group, Institute for Agriculture and the Environment, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Lindsay Brown
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, QLD 4350, Australia; Functional Foods Research Group, Institute for Agriculture and the Environment, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
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Telephone Encounters Predict Future High Financial Expenditures in Inflammatory Bowel Disease Patients: A 3-Year Prospective Observational Study. J Clin Gastroenterol 2018; 52:319-325. [PMID: 28452828 PMCID: PMC5659979 DOI: 10.1097/mcg.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Telephone activity is essential in management of complex chronic diseases including inflammatory bowel disease (IBD). Telephone encounters logged in the electronic medical record have recently been proposed as a surrogate marker of disease activity and impending health care utilization; however, the association between telephone calls and financial expenditures has not been evaluated. STUDY We performed a 3-year prospective observational study of telephone encounters logged at a tertiary referral IBD center. We analyzed patient demographics, disease characteristics, comorbidities, clinical activity, and health care financial charges by telephone encounter frequency. RESULTS Eight hundred one patients met inclusion criteria (52.3% female; mean age, 44.1 y), accounted for 12,669 telephone encounters, and accrued $70,513,449 in charges over 3 years. High telephone encounter frequency was associated with female gender (P=0.003), anxiety/depression (P<0.001), and prior IBD surgery (P<0.001). High telephone encounter categories had significantly more hospitalizations (P<0.001), IBD surgery (P<0.001), worse quality of life (P<0.001), more corticosteroid (P<0.001), biological (P<0.001), and opiate prescriptions (P<0.001). High telephone encounter frequency patients amassed higher total available charges in each year (P<0.001) and over the 3 years (P<0.001). Telephone encounters in 2009 (P=0.02) and 2010 (P<0.001) were significantly associated with financial charges the following year after controlling for demographic, utilization, and medication covariates. CONCLUSIONS Increased telephone encounters are associated with significantly higher health care utilization and financial expenditures. Increased call frequency is predictive of future health care spending. Telephone encounters are a useful tool to identify patients at risk of clinical deterioration and large financial expense.
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Chan W, Chen A, Tiao D, Selinger C, Leong R. Medication adherence in inflammatory bowel disease. Intest Res 2017; 15:434-445. [PMID: 29142511 PMCID: PMC5683974 DOI: 10.5217/ir.2017.15.4.434] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 01/26/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.
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Affiliation(s)
- Webber Chan
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Andy Chen
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Darren Tiao
- Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Christian Selinger
- IBD Unit, Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Rupert Leong
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
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40
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Kamat N, Ganesh Pai C, Surulivel Rajan M, Kamath A. Cost of Illness in Inflammatory Bowel Disease. Dig Dis Sci 2017; 62:2318-2326. [PMID: 28766243 DOI: 10.1007/s10620-017-4690-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/21/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Frequent relapses sometimes necessitating hospitalization and the absence of pharmacological cure contribute to substantial healthcare costs in inflammatory bowel diseases (IBDs). The costs of health care in Indian patients with IBD are unknown. AIM To evaluate the annual costs for treating Crohn's disease and ulcerative colitis. METHODS A prevalence-based, micro-costing method was used to assess the components of annual costs in a prospective, observational study conducted in a tertiary healthcare center enrolled over a 24-month period beginning of July 2014. RESULTS At enrollment, 43/59 (72.88%) patients with UC and 18/25 (72%) with CD were in remission. The annual median (IQR) cost per UC and CD patient in remission was INR 43,140 (34,357-51,031) [USD $707 (563-836)] and INR 43,763.5 (32,202-57,372) [USD $717 (527-940)], respectively, and in active disease was INR 52,436.5 (49,229-67,567.75) [$859 (807-1107)] and INR 72,145 (49,447-92,212) [USD $1182 (811-1512)], respectively. Compared with remission, active disease had a 1.4-fold higher cost for CD as compared to UC. In both groups, the greatest component of direct costs was drugs. Thirteen (22%) and 7 (28%) patients with UC and CD needed hospitalization accounting for 23.1 and 20.4% of the total costs, respectively. At one year, direct costs surmounted indirect costs in UC and CD (p < 0.001). Productivity losses contributed to 18.5 and 16% of the overall costs for UC and CD, respectively. CONCLUSION This first, panoptic, health economic study for IBD from India shows that the costs are driven by medication, productivity losses, and not merely hospitalization alone.
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Affiliation(s)
- Nagesh Kamat
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, 576104, India
| | - C Ganesh Pai
- Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, 576104, India.
| | - M Surulivel Rajan
- Department of Pharmacotherapy, UNTS College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, 576104, India
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Con D, Jackson B, Gray K, De Cruz P. eHealth for inflammatory bowel disease self-management - the patient perspective. Scand J Gastroenterol 2017; 52:973-980. [PMID: 28598210 DOI: 10.1080/00365521.2017.1333625] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Electronic health (eHealth) solutions may help address the growing pressure on IBD outpatient services as they encompass a component of self-management. However, information regarding patients' attitudes towards the use of eHealth solutions in IBD is lacking. OBJECTIVE The aim of this study was to evaluate eHealth technology use and explore the perspectives of IBD patients on what constitutes the ideal eHealth solution to facilitate self-management. METHODS A mixed methods qualitative and quantitative analysis of the outcomes of a discussion forum and an online survey conducted at a tertiary hospital in Melbourne, Australia between November 2015 and January 2016 was undertaken. RESULTS Eighteen IBD patients and parents participated in the discussion forum. IBD patients expressed interest in eHealth tools that are convenient and improve access to care, communication, disease monitoring and adherence. Eighty six patients with IBD responded to the online survey. A majority of patients owned a mobile phone (98.8%), had access to the internet (97.7%), and felt confident entering data onto a phone or computer (73.3%). Most patients (98.8%) were willing to use at least one form of information and communication technology to help manage their IBD. Smartphone apps and internet websites were the two most preferred technologies to facilitate IBD self-management. CONCLUSIONS This study demonstrates the willifngness of patients to engage with eHealth as a potential solution to facilitate IBD self-management. Future development and testing of eHealth solutions should be informed by all major stakeholders including patients to maximise their uptake and efficacy to facilitate IBD self-management.
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Affiliation(s)
- Danny Con
- a Faculty of Medicine, Dentistry and Health Sciences , The University of Melbourne , Melbourne , Australia.,b Department of Gastroenterology , Austin Hospital , Melbourne , Australia
| | - Belinda Jackson
- b Department of Gastroenterology , Austin Hospital , Melbourne , Australia
| | - Kathleen Gray
- c Health and Biomedical Informatics Centre , The University of Melbourne , Melbourne , Australia
| | - Peter De Cruz
- b Department of Gastroenterology , Austin Hospital , Melbourne , Australia.,d Department of Medicine , Austin Academic Centre, The University of Melbourne , Melbourne , Australia
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Aguas M, Del Hoyo J, Faubel R, Valdivieso B, Nos P. Telemedicine in the treatment of patients with inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:641-647. [PMID: 28797518 DOI: 10.1016/j.gastrohep.2017.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/27/2017] [Accepted: 07/05/2017] [Indexed: 01/26/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic and relapsing disorder with significant medical, social and financial impacts. IBD patients require continuous follow-up, and healthcare resource use in this context increases over time. In the last decade, telemedicine has influenced the treatment of chronic diseases like IBD via the application of information and communication technologies to provide healthcare services remotely. Telemedicine and its various applications (telemanagement, teleconsulting and tele-education) enable closer follow-up and provide education resources that promote patient empowerment, encouraging treatment optimisation over the entire course of the disease. We describe the impact of using telemedicine on IBD health outcomes and discuss the limitations of implementing these systems in the real-life management of IBD patients.
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Affiliation(s)
- Mariam Aguas
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Medicina Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Instituto de Investigación Sanitaria La Fe, Valencia, España.
| | - Javier Del Hoyo
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Medicina Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Raquel Faubel
- Unidad de Investigación Conjunta en Ingeniería Biomédica - Tecnologías de la Información y la Comunicación aplicadas a la Reingeniería de Procesos Socio-Sanitarios (eRPSS: IIS La Fe-UPV), Universitat de València, España
| | - Bernardo Valdivieso
- Instituto de Investigación sanitaria La Fe, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Pilar Nos
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Medicina Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Instituto de Investigación Sanitaria La Fe, Valencia, España
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Smolinska A, Bodelier AGL, Dallinga JW, Masclee AAM, Jonkers DM, van Schooten FJ, Pierik MJ. The potential of volatile organic compounds for the detection of active disease in patients with ulcerative colitis. Aliment Pharmacol Ther 2017; 45:1244-1254. [PMID: 28239876 DOI: 10.1111/apt.14004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 07/26/2016] [Accepted: 02/01/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND To optimise treatment of ulcerative colitis (UC), patients need repeated assessment of mucosal inflammation. Current non-invasive biomarkers and clinical activity indices do not accurately reflect disease activity in all patients and cannot discriminate UC from non-UC colitis. Volatile organic compounds (VOCs) in exhaled air could be predictive of active disease or remission in Crohn's disease. AIM To investigate whether VOCs are able to differentiate between active UC, UC in remission and non-UC colitis. METHODS UC patients participated in a 1-year study. Clinical activity index, blood, faecal and breath samples were collected at each out-patient visit. Patients with clear defined active faecal calprotectin >250 μg/g and inactive disease (Simple Clinical Colitis Activity Index <3, C-reactive protein <5 mg/L and faecal calprotectin <100 μg/g) were included for cross-sectional analysis. Non-UC colitis was confirmed by stool culture or radiological evaluation. Breath samples were analysed by gas chromatography time-of-flight mass spectrometry and kernel-based method to identify discriminating VOCs. RESULTS In total, 72 UC (132 breath samples; 62 active; 70 remission) and 22 non-UC-colitis patients (22 samples) were included. Eleven VOCs predicted active vs. inactive UC in an independent internal validation set with 92% sensitivity and 77% specificity (AUC 0.94). Non-UC colitis patients could be clearly separated from active and inactive UC patients with principal component analysis. CONCLUSIONS Volatile organic compounds can accurately distinguish active disease from remission in UC and profiles in UC are clearly different from profiles in non-UC colitis patients. VOCs have demonstrated potential as new non-invasive biomarker to monitor inflammation in UC.
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Affiliation(s)
- A Smolinska
- Department of Pharmacology and Toxicology, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A G L Bodelier
- Department of Gastroenterology and Hepatology, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - J W Dallinga
- Department of Pharmacology and Toxicology, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A A M Masclee
- Department of Gastroenterology and Hepatology, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - D M Jonkers
- Department of Gastroenterology and Hepatology, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - F-J van Schooten
- Department of Pharmacology and Toxicology, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - M J Pierik
- Department of Gastroenterology and Hepatology, NUTRIM School for Nutrition, and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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44
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Siegel CA. Transforming Gastroenterology Care With Telemedicine. Gastroenterology 2017; 152:958-963. [PMID: 28192101 DOI: 10.1053/j.gastro.2017.01.048] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 01/01/2017] [Accepted: 01/08/2017] [Indexed: 02/07/2023]
Abstract
Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients-especially those with chronic diseases-does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy.
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Affiliation(s)
- Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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45
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Schmidt-Weitmann S, Grischott T, Bauerfeind P, Brockes C. Medical online consultation service in gastroenterology at the University Hospital Zurich. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1334409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sabine Schmidt-Weitmann
- Clinical Telemedicine, University Hospital Zurich, Sonneggstrasse 12, 8091 Zurich, Switzerland
| | - Thomas Grischott
- Clinical Telemedicine, University Hospital Zurich, Sonneggstrasse 12, 8091 Zurich, Switzerland
| | - Peter Bauerfeind
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Christiane Brockes
- Clinical Telemedicine, University Hospital Zurich, Sonneggstrasse 12, 8091 Zurich, Switzerland
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Dykes D, Williams E, Margolis P, Ruschman J, Bick J, Saeed S, Opipari L. Improving pediatric Inflammatory Bowel Disease (IBD) follow-up. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu208961.w3675. [PMID: 27559472 PMCID: PMC4994093 DOI: 10.1136/bmjquality.u208961.w3675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/01/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
Standardization of Inflammatory Bowel Disease (IBD) care through participation in the ImproveCareNow (ICN) Network has improved outcomes for pediatric patients with IBD, but under the current care model, our improvements have plateaued. Current ICN model care guidelines recommend health supervision visits every six months. We identified a gap in our practice's ability to ensure either a routine six month follow-up or a rapid follow-up after a disease flare, and a significant number of patients with active disease status during a six month period lacked timely reassessment after interventions or medication changes. Telemedicine provides an alternative method of care delivery to address these gaps, but has had limited use in patients with IBD. A multi-step approach to offer alternative follow-up care options via telemedicine was developed with potential impact on remission rates and quality of life. Short term goals of the pilot were to improve telemedicine access for patients with IBD were to 1) increase the percent of patients with active disease with a follow-up completed within two months of a visit from 40% to 70%, 2) increase the percent of patients with a visit scheduled within two months of their last sick visit from 20% to 70% (interim measure), 3) increase the number of eVisits from zero visits per month to two visits per month during pilot phase, 4) increase electronic communication with patients from zero messages per month to 200 messages per month, 5) no change in complications or adverse events (defined as an unplanned visit or ED (emergency department) encounter within 30 days of an eVisit. The expected outcomes of the e-visit model were to: maintain baseline care standards and health screening capabilities, improve access to care, and provide equivalent care delivery (no increase in the number of unplanned clinical encounters). Using the IHI model for improvement (Plan-Do-Study-Act) we have seen a progressive increase in the rate of patient signups for the electronic medical record patient portal, with a baseline median of 20% per clinic compared with a current median of approximately 70% after six months. We successfully implemented e-messaging in its pilot form among five providers and have seen steady uptake in patient use from 5 patient initiated messages during the first month to 76 messages/month over the past three months. E-visits have replaced a total of 32 visits to date. Medications, nutrition, and disease activity were appropriately screened and managed electronically without the need for a physical office visit by the treating gastroenterologist. Access to care was improved in that all patients completed their e-visits from their homes without missing school or work and did not require a physical office visit. One visit successfully identified worsening of the patient's clinical course and resulted in a scheduled office visit request, but no unplanned office visits or ED visits have occurred. This report represents the first description of telemedicine use in routine clinical care in children with IBD. We anticipate continuing use of this novel mode of health care delivery in pediatrics in an effort to increase the proportion of patients seen for interval follow-up, after IBD diagnosis, or mild flare in an effort to target early treatment changes that should result in improved remission and patient reported outcomes. E-visits are less expensive and time consuming than traditional visits and may serve as an additional method of cost savings by matching care to a patient's individual needs.
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Affiliation(s)
- Dana Dykes
- Cincinnati Children's Hospital Medical Center, USA
| | | | | | | | | | | | - Lisa Opipari
- Cincinnati Children's Hospital Medical Center, USA
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47
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Aguas M, Del Hoyo J, Faubel R, Nos P. Use of telemedicine in inflammatory bowel disease: a real monitoring option? Expert Rev Gastroenterol Hepatol 2016; 10:879-81. [PMID: 27291621 DOI: 10.1080/17474124.2016.1200464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- M Aguas
- a Health Research Institute 'La Fe University Hospital' , Valencia , Spain.,b CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Diseases) , Valencia , Spain.,c Gastroenterology Department , La Fe University and Politechnic Hospital , Valencia , Spain
| | - J Del Hoyo
- c Gastroenterology Department , La Fe University and Politechnic Hospital , Valencia , Spain
| | - R Faubel
- d University of Valencia , Valencia , Spain.,e Joint Research Unit in Biomedical Engineering - eRPSS (ICT applied to healthcare process re-engineering) IIS La Fe-UPV , Valencia , Spain.,f Health Services Research on Chronic Patients Network (REDISSEC) , Valencia , Spain
| | - P Nos
- a Health Research Institute 'La Fe University Hospital' , Valencia , Spain.,b CIBEREHD (Networked Biomedical Research Center for Hepatic and Digestive Diseases) , Valencia , Spain.,c Gastroenterology Department , La Fe University and Politechnic Hospital , Valencia , Spain
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49
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Marín-Jiménez I, Nos P, Domènech E, Riestra S, Gisbert JP, Calvet X, Cortés X, Iglesias E, Huguet JM, Taxonera C, Fernández R, Carpio D, Gutiérrez A, Guardiola J, Laria LC, Sicilia B, Bujanda L, Cea-Calvo L, Romero C, Rincón Ó, Juliá B, Panés J. Diagnostic Performance of the Simple Clinical Colitis Activity Index Self-Administered Online at Home by Patients With Ulcerative Colitis: CRONICA-UC Study. Am J Gastroenterol 2016; 111:261-268. [PMID: 26753886 DOI: 10.1038/ajg.2015.403] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES New e-health technologies can improve patient-physician communication and contribute to optimal patient care. We compared the diagnostic performance of the Simple Clinical Colitis Activity Index (SCCAI) self-administered by patients with ulcerative colitis (UC) at home (through a website) with the in-clinic gastroenterologist-assessed SCCAI. METHODS Patients were followed-up over 6 months. At months 3 and 6, patients completed the SCCAI online at home; within 48 h, gastroenterologists (blinded to patients' scores) completed the in-clinic SCCAI (reference). SCCAI scores were dichotomized to remission or active disease, and SCCAI changes in disease activity from month 3 to 6 were classed as worsening, stability, or improvement. RESULTS A total of 199 patients (median age: 38 years; 56% female) contributed with 340 pairs of questionnaires. Correlation of SCCAI scores by patients and physicians was good (Spearman's ρ=0.79), with 85% agreement for remission or activity (95% CI: 80.8-88.6, κ=0.66). The negative predictive value for active disease was 94.5% (91.4-96.6); the positive predictive value was 68.0% (58.8-69.2). Agreement between patient and physician was higher in the 168 month 6 pairs than in the 172 month 3 pairs of questionnaires (89.3% (83.6-93.1) vs. 80.8% (74.2-86.0), P=0.027). CONCLUSIONS In patients with UC, SCCAI self-administration via an online tool resulted in a high percentage of agreement with evaluation by gastroenterologists, with a remarkably high negative predictive value for disease activity. Remote monitoring of UC patients is possible and might reduce hospital visits.
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Affiliation(s)
- Ignacio Marín-Jiménez
- Gastroenterology Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Pilar Nos
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Eugeni Domènech
- Gastroenterology Unit, Hospital Universitari Germans Trias i Pujol (Badalona), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
| | - Sabino Riestra
- Department of Gastroenterology, Inflammatory Bowel Disease Unit, Central University Hospital of Asturias, Oviedo, Spain
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y digestivas (CIBERehd), Madrid, Spain
| | - Xavier Calvet
- Gastroenterology Unit, Hospital de Sabadell e Institut Universitari Parc Tauli, Sabadell, Spain
| | - Xavier Cortés
- Gastroenterology Unit, Hospital de Sagunto, Valencia, Spain
| | - Eva Iglesias
- Department of Gastroenterology, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Jose M Huguet
- Hospital General Universitario de Valencia, Valencia, Spain
| | - Carlos Taxonera
- Gastroenterology Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Ramón Fernández
- Gastroenterology Unit, Hospital General de Jaén, Jaén, Spain
| | - Daniel Carpio
- IBD Unit, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Ana Gutiérrez
- Gastroenterology Unit, Hospital General Universitario Alicante, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Alicante, Spain
| | - Jordi Guardiola
- Gastroenterology Unit Hospital de Bellvitge, Idibell, Barcelona, Spain
| | - Luisa Castro Laria
- Gastroenterology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Beatriz Sicilia
- Gastroenterology Unit, Hospital General de Burgos, Burgos, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Luis Cea-Calvo
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
| | - Cristina Romero
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
| | - Óscar Rincón
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
| | - Berta Juliá
- Medical Affairs Department, Merck Sharp & Dohme Spain, Madrid, Spain
| | - Julián Panés
- Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Telephone Consultation as a Substitute for Routine Out-patient Face-to-face Consultation for Children With Inflammatory Bowel Disease: Randomised Controlled Trial and Economic Evaluation. EBioMedicine 2015; 2:1251-6. [PMID: 26501125 PMCID: PMC4588430 DOI: 10.1016/j.ebiom.2015.08.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/29/2015] [Accepted: 08/05/2015] [Indexed: 11/22/2022] Open
Abstract
Background Evidence for the use of telephone consultation in childhood inflammatory bowel disease (IBD) is lacking. We aimed to assess the effectiveness and cost consequences of telephone consultation compared with the usual out-patient face-to-face consultation for young people with IBD. Methods We conducted a randomised-controlled trial in Manchester, UK, between July 12, 2010 and June 30, 2013. Young people (aged 8–16 years) with IBD were randomized to receive telephone consultation or face-to-face consultation for 24 months. The primary outcome measure was the paediatric IBD-specific IMPACT quality of life (QOL) score at 12 months. Secondary outcome measures included patient satisfaction with consultations, disease course, anthropometric measures, proportion of consultations attended, duration of consultations, and costs to the UK National Health Service (NHS). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02319798. Findings Eighty six patients were randomised to receive either telephone consultation (n = 44) or face-to-face consultation (n = 42). Baseline characteristics of the two groups were well balanced. At 12 months, there was no evidence of difference in QOL scores (estimated treatment effect in favour of the telephone consultation group was 5.7 points, 95% CI − 2.9 to 14.3; p = 0.19). Mean consultation times were 9.8 min (IQR 8 to 12.3) for telephone consultation, and 14.3 min (11.6 to 17.0) for face-to-face consultation with an estimated reduction (95% CI) of 4.3 (2.8 to 5.7) min in consultation times (p < 0.001). Telephone consultation had a mean cost of UK£35.41 per patient consultation compared with £51.12 for face-face consultation, difference £15.71 (95% CI 11.8–19.6; P < 0.001). Interpretation We found no suggestion of inferiority of telephone consultation compared with face-to-face consultation with regard to improvements in QOL scores, and telephone consultation reduced consultation time and NHS costs. Telephone consultation is a cost-effective alternative to face-to-face consultation for the routine outpatient follow-up of children and adolescents with IBD. Funding Research for Patient Benefit Programme, UK National Institute for Health Research.
This is the first randomised controlled trial that has formally investigated the role of telephone consultation in paediatric inflammatory bowel disease. This study contributes evidence showing that telephone consultation as a substitute for routine outpatient follow-up is feasible and effective. There was no suggestion of inferiority of telephone consultation compared with face-to-face consultation with regard to improvements in quality of life scores, and telephone consultation reduced consultation time and NHS costs. Telephone consultation is a cost-effective alternative to face-to-face consultation for the routine outpatient follow-up of children and adolescents with inflammatory bowel disease.
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