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Al-Sheikh M, Ankersen DV, Olsen J, Spanggaard M, Peters-Lehm CT, Naimi RM, Bennedsen M, Burisch J, Munkholm P. The Costs of Home Monitoring by Telemedicine vs Standard Care for Inflammatory Bowel Diseases-A Danish Register-Based, 5-Year Follow-up Study. J Crohns Colitis 2025; 19:jjae120. [PMID: 39110131 PMCID: PMC11836881 DOI: 10.1093/ecco-jcc/jjae120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/11/2024] [Accepted: 08/06/2024] [Indexed: 02/20/2025]
Abstract
BACKGROUND AND AIMS There are few studies on the cost-effectiveness of telemedicine for inflammatory bowel diseases. We assessed the long-term cost-effectiveness of a telemedicine solution compared to standard care (sCare), as well as its efficacy according to patient-reported outcomes (PROs). METHODS Between 2015 and 2020, we conducted a retrospective, register-based study among patients with ulcerative colitis and Crohn's disease. Direct and indirect healthcare costs over a 5-year period were obtained from Danish registers and compared to a control group. Costs were estimated on a yearly basis from 1 year before, until 5 years after, inclusion in the trial. Patients were divided into 2 groups: those not receiving biologics (Cohort 1) and those receiving biologics (Cohort 2). RESULTS We recruited 574 patients with inflammatory bowel diseases. In Cohort 1 (61.5%), average total direct costs and total earnings per patient per year were €14 043 and €307 793, respectively, in telemedicine compared to €16 226 and €252 166, respectively, in sCare. In Cohort 2 (38.5%), average total direct costs and total earnings were €73 916 and €215 833, respectively, in telemedicine compared to €41 748 and €203 667, respectively, in sCare. PROs showed improved quality of life, which was higher in Cohort 1 than in Cohort 2. Disease activity among patients with Crohn's disease increased after Years 3 and 4 in Cohorts 1 and 2, respectively. CONCLUSION Telemedicine is cost-effective for patients not receiving biologics. However, treatment with biologics is more expensive for patients enrolled in telemedicine. Careful attention to PROs in telemedicine improves quality of life and could prolong the time to relapse.
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Affiliation(s)
- Marwah Al-Sheikh
- Department of Gastroenterology, Medical Division, Copenhagen University Hospital, North Zealand, Denmark
| | - Dorit Vedel Ankersen
- Department of Gastroenterology, Medical Division, Copenhagen University Hospital, North Zealand, Denmark
| | | | | | - Charlotte T Peters-Lehm
- Department of Gastroenterology, Medical Division, Copenhagen University Hospital, North Zealand, Denmark
| | - Rahim M Naimi
- Department of Gastroenterology, Medical Division, Copenhagen University Hospital, North Zealand, Denmark
| | - Mette Bennedsen
- Department of Gastroenterology, Medical Division, Copenhagen University Hospital, North Zealand, Denmark
| | - Johan Burisch
- Gastro Unit, Medical Division, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, Medical Division, Copenhagen University Hospital, North Zealand, Denmark
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Asadi F, Hosseini A, Daeechini AH. Designing the Essential Informational Needs of a Smartphone Application for Self-Management of Patients With Inflammatory Bowel Disease. Health Sci Rep 2024; 7:e70186. [PMID: 39558932 PMCID: PMC11570870 DOI: 10.1002/hsr2.70186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/24/2024] [Accepted: 10/15/2024] [Indexed: 11/20/2024] Open
Abstract
Background and Aims Inflammatory bowel disease (IBD) is a chronic digestive disease that has a detrimental effect on the quality of life of IBD patients. This study aims to identify the informational needs and design the essential informational needs for a smartphone application for the self-management of IBD. Methods This study was conducted in two stages and the informational needs of the patients were extracted in a questionnaire designed in three separate sections and given to 120 patients with UC and 60 patients with CD. Results After a literature review and analysis of patient responses, it was found that Knowledge of the disease, Medication, Educational information, Complications, Diet & Nutrition, and Lifestyle habits are among the most important domains of informational needs of inflammatory bowel disease patients. Conclusion Patients with IBD have many informational needs, and in this study, identifying these needs, can help improve the quality of life of these patients and be of interest to healthcare providers, designers, and developers of applications.
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Affiliation(s)
- Farkhondeh Asadi
- Department of Health Information Technology and ManagementSchool of Allied Medical Sciences, Shahid Beheshti University of Medical SciencesTehranIran
| | - Azamossadat Hosseini
- Department of Health Information Technology and ManagementSchool of Allied Medical Sciences, Shahid Beheshti University of Medical SciencesTehranIran
| | - Amir Hossein Daeechini
- Department of Health Information Technology and ManagementSchool of Allied Medical Sciences, Shahid Beheshti University of Medical SciencesTehranIran
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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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Ren C, Zhou Y, Cai Q, Zhou M. Summary of the best evidence on self-management support schemes for patients with inflammatory bowel disease based on mobile health systems. Digit Health 2024; 10:20552076241261906. [PMID: 38868366 PMCID: PMC11168054 DOI: 10.1177/20552076241261906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
Objective Self-management support services can improve patients' self-management ability. This study summarized the best evidence on a self-management support scheme for patients with inflammatory bowel disease based on a mobile health system to accurately describe the current status of the field and provide recommendations for healthcare workers. Methods Two researchers retrieved studies from computer decision support systems, guideline websites, official association websites, and databases from the establishment of the database until October 2023. The quality of the included studies was independently evaluated by two authors using the Appraisal of Guidelines for Research and Evaluation Instrument II and the 2016 version of the corresponding evaluation standards of the Australian Joanna Briggs Institute Evidence-based Health Care Center. The classification of evidence and recommendation level adopted the 2014 version of the Australian Joanna Briggs Institute evidence pregrading and recommending level system. Results Fifteen studies were included, comprising one guideline, two expert consensuses, four systematic reviews, four quasi-experimental studies, and four qualitative studies. The overall quality of the included studies was moderate to high. Thirty-six pieces of best evidence were compiled for seven elements, namely, mobile health system type and functional support; mobile health system application preparation; health information recording, uploading, and presentation; zoning management of diseases and early warning of the active period; support related to health education; healthcare support team formation and services; and virtual communities. Conclusions Our study evaluated the quality of the included studies and summarized a self-management support scheme for patients with inflammatory bowel disease based on a mobile health system. The main scheme was divided into 7 parts and 36 items, which can be used as a reference for healthcare workers so that they can provide more comprehensive and scientific self-management support services for patients with inflammatory bowel disease through mobile health systems.
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Affiliation(s)
- Chenfei Ren
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qian Cai
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mi Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Jannati N, Salehinejad S, Kuenzig ME, Peña-Sánchez JN. Review and content analysis of mobile apps for inflammatory bowel disease management using the mobile application rating scale (MARS): Systematic search in app stores. Int J Med Inform 2023; 180:105249. [PMID: 37857167 DOI: 10.1016/j.ijmedinf.2023.105249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND People with inflammatory bowel disease (IBD) need tools for self-management of their disease with the ultimate goal of improving medication adherence and health outcomes. Mobile apps represent a novel opportunity to provide self-management for patients with IBD. Many mobile apps have been developed for IBD self-management, but more evidence is needed about the quality of these mobile apps. OBJECTIVE This study evaluated mobile apps developed for the IBD community and rated the quality of these apps to provide a roadmap for future development. MATERIALS AND METHODS The Apple App Store and Google Play Store were systematically searched to identify IBD mobile apps for patients and physicians based on the IBD-related keywords. We included mobile apps that focus on IBD, are in the English language, and are free. The related app quality was evaluated independently by two reviewers using the Mobile Application Rating Scale (MARS). RESULTS We identified 401 mobile apps. After removing duplicates and unrelated apps, 44 apps were included in the review. Overall, the mean MARS scores were 3.5 (SD = 0.5) on a scale from 1.00 to 5.00, which was the acceptable range.; 12 apps got scores ≥ 4.00. The highest mean domain score belonged to the functionality dimension (mean = 3.9, SD = 0.6) and the lowest belonged to the engagement dimension (mean = 3.2, SD = 0.8). CONCLUSION The MARS ratings showed that the IBD mobile apps quality meet acceptable criteria. However, more attention must be paid to design features that improve user interest and engagement, especially among children and adolescents. Healthcare professional involvement is crucial for designing mobile health apps.
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Affiliation(s)
- Nazanin Jannati
- Department of Community Health & Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Canada.
| | - Simin Salehinejad
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - M Ellen Kuenzig
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada; SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health & Epidemiology, College of Medicine, University Saskatchewan, Saskatoon, Canada.
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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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Gordon M, Sinopoulou V, Lakunina S, Gjuladin-Hellon T, Bracewell K, Akobeng AK. Remote care through telehealth for people with inflammatory bowel disease. Cochrane Database Syst Rev 2023; 5:CD014821. [PMID: 37140025 PMCID: PMC10164701 DOI: 10.1002/14651858.cd014821.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND People with inflammatory bowel disease (IBD) require intensive follow-up with frequent consultations after diagnosis. IBD telehealth management includes consulting by phone, instant messenger, video, text message, or web-based services. Telehealth can be beneficial for people with IBD, but may have its own set of challenges. It is important to systematically review the evidence on the types of remote or telehealth approaches that can be deployed in IBD. This is particularly relevant following the coronavirus disease 2019 (COVID-19) pandemic, which led to increased self- and remote-management. OBJECTIVES To identify the communication technologies used to achieve remote healthcare for people with inflammatory bowel disease and to assess their effectiveness. SEARCH METHODS On 13 January 2022, we searched CENTRAL, Embase, MEDLINE, three other databases, and three trials registries with no limitations on language, date, document type, or publication status. SELECTION CRITERIA All published, unpublished, and ongoing randomised controlled trials (RCTs) that evaluated telehealth interventions targeted at people with IBD versus any other type of intervention or no intervention. We did not include studies based on digital patient information resources or education resources, unless they formed part of a wider package including an element of telehealth. We excluded studies where remote monitoring of blood or faecal tests was the only form of monitoring. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included studies and assessed their risk of bias. We analysed studies on adult and paediatric populations separately. We expressed the effects of dichotomous outcomes as risk ratios (RRs) and the effects of continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs), each with their 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE methodology. MAIN RESULTS We included 19 RCTs with a total of 3489 randomised participants, aged eight to 95 years. Three studies examined only people with ulcerative colitis (UC), two studies examined only people with Crohn's disease (CD), and the remaining studies examined a mix of IBD patients. Studies considered a range of disease activity states. The length of the interventions ranged from six months to two years. The telehealth interventions were web-based and telephone-based. Web-based monitoring versus usual care Twelve studies compared web-based disease monitoring to usual care. Three studies, all in adults, provided data on disease activity. Web-based disease monitoring (n = 254) is probably equivalent to usual care (n = 174) in reducing disease activity in people with IBD (SMD 0.09, 95% CI -0.11 to 0.29). The certainty of the evidence is moderate. Five studies on adults provided dichotomous data that we could use for a meta-analysis on flare-ups. Web-based disease monitoring (n = 207/496) is probably equivalent to usual care (n = 150/372) for the occurrence of flare-ups or relapses in adults with IBD (RR 1.09, 95% CI 0.93 to 1.27). The certainty of the evidence is moderate. One study provided continuous data. Web-based disease monitoring (n = 465) is probably equivalent to usual care (n = 444) for the occurrence of flare-ups or relapses in adults with CD (MD 0.00 events, 95% CI -0.06 to 0.06). The certainty of the evidence is moderate. One study provided dichotomous data on flare-ups in a paediatric population. Web-based disease monitoring (n = 28/84) may be equivalent to usual care (n = 29/86) for the occurrence of flare-ups or relapses in children with IBD (RR 0.99, 95% CI 0.65 to 1.51). The certainty of the evidence is low. Four studies, all in adults, provided data on quality of life. Web-based disease monitoring (n = 594) is probably equivalent to usual care (n = 505) for quality of life in adults with IBD (SMD 0.08, 95% CI -0.04 to 0.20). The certainty of the evidence is moderate. Based on continuous data from one study in adults, we found that web-based disease monitoring probably leads to slightly higher medication adherence compared to usual care (MD 0.24 points, 95% CI 0.01 to 0.47). The results are of moderate certainty. Based on continuous data from one paediatric study, we found no difference between web-based disease monitoring and usual care in terms of their effect on medication adherence (MD 0.00, 95% CI -0.63 to 0.63), although the evidence is very uncertain. When we meta-analysed dichotomous data from two studies on adults, we found no difference between web-based disease monitoring and usual care in terms of their effect on medication adherence (RR 0.87, 95% CI 0.62 to 1.21), although the evidence is very uncertain. We were unable to draw any conclusions on the effects of web-based disease monitoring compared to usual care on healthcare access, participant engagement, attendance rate, interactions with healthcare professionals, and cost- or time-effectiveness. The certainty of the evidence is very low. AUTHORS' CONCLUSIONS The evidence in this review suggests that web-based disease monitoring is probably no different to standard care in adults when considering disease activity, occurrence of flare-ups or relapse, and quality of life. There may be no difference in these outcomes in children, but the evidence is limited. Web-based monitoring probably increases medication adherence slightly compared to usual care. We are uncertain about the effects of web-based monitoring versus usual care on our other secondary outcomes, and about the effects of the other telehealth interventions included in our review, because the evidence is limited. Further studies comparing web-based disease monitoring to standard care for the clinical outcomes reported in adults are unlikely to change our conclusions, unless they have longer follow-up or investigate under-reported outcomes or populations. Studies with a clearer definition of web-based monitoring would enhance applicability, enable practical dissemination and replication, and enable alignment with areas identified as important by stakeholders and people affected by IBD.
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Affiliation(s)
- Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | | | | | - Teuta Gjuladin-Hellon
- School of Medicine, University of Central Lancashire, Preston, UK
- Centre for Guidelines, National Institute for Health and Care Excellence (NICE), Manchester, UK
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Gordon M, Sinopoulou V, Ibrahim U, Abdulshafea M, Bracewell K, Akobeng AK. Patient education interventions for the management of inflammatory bowel disease. Cochrane Database Syst Rev 2023; 5:CD013854. [PMID: 37172140 PMCID: PMC10162698 DOI: 10.1002/14651858.cd013854.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a life-long condition for which currently there is no cure. Patient educational interventions deliver structured information to their recipients. Evidence suggests patient education can have positive effects in other chronic diseases. OBJECTIVES To identify the different types of educational interventions, how they are delivered, and to determine their effectiveness and safety in people with IBD. SEARCH METHODS On 27 November 2022, we searched CENTRAL, Embase, MEDLINE, ClinicalTrials.gov, and WHO ICTRP with no limitations to language, date, document type, or publication status. Any type of formal or informal educational intervention, lasting for any time, that had content focused directly on knowledge about IBD or skills needed for direct management of IBD or its symptoms was included. Delivery methods included face-to-face or remote educational sessions, workshops, guided study via the use of printed or online materials, the use of mobile applications, or any other method that delivers information to patients. SELECTION CRITERIA All published, unpublished and ongoing randomised control trials (RCTs) that compare educational interventions targeted at people with IBD to any other type of intervention or no intervention. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and risk of bias assessment of the included studies. We analysed data using Review Manager Web. We expressed dichotomous and continuous outcomes as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE methodology. MAIN RESULTS We included 14 studies with a total of 2708 randomised participants, aged 11 to 75 years. Two studies examined populations who all had ulcerative colitis (UC); the remaining studies examined a mix of IBD patients (UC and Crohn's disease). Studies considered a range of disease activity states. The length of the interventions ranged from 30 minutes to 12 months. Education was provided in the form of in-person workshops/lectures, and remotely via printed materials or multimedia, smartphones and internet learning. Thirteen studies compared patient education interventions plus standard care against standard care alone. The interventions included seminars, information booklets, text messages, e-learning, a multi professional group-based programme, guidebooks, a staff-delivered programme based on an illustrated book, a standardised programme followed by group session, lectures alternating with group therapy, educational sessions based on an IBD guidebook, internet blog access and text messages, a structured education programme, and interactive videos. Risk of bias findings were concerning in all judgement areas across all studies. No single study was free of unclear or high of bias judgements. Reporting of most outcomes in a homogeneous fashion was limited, with quality of life at study end reported most commonly in six of the 14 studies which allowed for meta-analysis, with all other outcomes reported in a more heterogeneous manner that limited wider analysis. Two studies provided data on disease activity. There was no clear difference in disease activity when patient education (n = 277) combined with standard care was compared to standard care (n = 202). Patient education combined with standard care is probably equivalent to standard care in reducing disease activity in patients with IBD (standardised mean difference (SMD) -0.03, 95% CI -0.25 to 0.20), moderate-certainty evidence. Two studies provided continuous data on flare-up/relapse. There was no clear difference for flare-ups or relapse when patient education (n = 515) combined with standard care was compared to standard care (n = 507), as a continuous outcome. Patient education combined with standard care is probably equivalent to standard care in reducing flare-ups or relapse in patients with IBD (MD -0.00, 95% CI -0.06 to 0.05; moderate-certainty evidence). Three studies provided dichotomous data on flare-up/relapse. The evidence is very uncertain on whether patient education combined with standard care (n = 157) is different to standard care (n = 150) in reducing flare-ups or relapse in patients with IBD (RR 0.94, 95% CI 0.41 to 2.18; very low-certainty evidence). Six studies provided data on quality of life. There was no clear difference in quality of life when patient education combined with standard care (n = 721) was compared to standard care (n = 643). Patient education combined with standard care is probably equivalent to standard care in improving quality of life in patients with IBD (SMD 0.08, 95% CI -0.03 to 0.18; moderate-certainty evidence). The included studies did not report major differences on healthcare access. Medication adherence, patient knowledge and change in quality of life showed conflicting results that varied between no major differences and differences in favour of the educational interventions. Only five studies reported on adverse events. Four reported zero total adverse events and one reported one case of breast cancer and two cases of surgery in their interventions groups, and zero adverse events in their control group. Two studies compared delivery methods of patient education, specifically: web-based patient education interventions versus colour-printed books or text messages; and one study compared frequency of patient education, specifically: weekly educational text messages versus once every other week educational text messages. These did not show major differences for disease activity and quality of life. Other outcomes were not reported. AUTHORS' CONCLUSIONS The ways in which patient educational support surrounding IBD may impact on disease outcomes is complex. There is evidence that education added to standard care is probably of no benefit to disease activity or quality of life when compared with standard care, and may be of no benefit for occurrence of relapse when compared with standard care. However, as there was a paucity of specific information regarding the components of education or standard care, the utility of these findings is questionable. Further research on the impact of education on our primary outcomes of disease activity, flare-ups/relapse and quality of life is probably not indicated. However, further research is necessary, which should focus on reporting details of the educational interventions and study outcomes that educational interventions could be directly targeted to address, such as healthcare access and medication adherence. These should be informed by direct engagement with stakeholders and people affected by Crohn's and colitis.
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Affiliation(s)
- Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
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Chauhan U, Stitt L, Rohatinsky N, Watson M, Currie B, Westin L, McCaw W, Norton C, Nistor I. Patients' Access to Telephone and E-mail Services Provided by IBD Nurses in Canada. J Can Assoc Gastroenterol 2022; 5:129-136. [PMID: 35669845 DOI: 10.1093/jcag/gwab041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) can impact the quality of life and increase health care resource utilization. Nurses play an integral role in ensuring ease of access to care between scheduled office visits. Aims This study aimed to capture the utilization of Canadian IBD nursing telephone and e-mail services. Methods A descriptive cross-sectional study with an eight-item online survey was completed by nurses to assess the use of nurse-led telephone and e-mail services for IBD patients. Results Twenty-one IBD nurses participated, and 572 patients nurse encounters were reported. Patients with ulcerative (UC) contacted with disease flare when compared to Crohn's disease (CD) (40% versus 24%, P < 0.001). Nursing services were primarily utilized for queries regarding medication (39.3%), disease exacerbations (29.6%), investigations (26%), and scheduling appointments (17.6%). Patients with CD had more telephone conversations (62.7%) and required more follow-up telephone calls (72.2%) compared to patients with UC (33%) and 25%, respectively. Nurse-managed interventions were provided independently for 61.4% of encounters, while 19% required a scheduled appointment in the IBD clinic. In the absence of telephone or e-mail assistance, older patients were more likely to call their family doctor (r = 0.18, P < 0.001), visit the emergency room (r = 0.18, P < 0.001), visit an urgent access clinic (r = 0.22, P < 0.001), or visit a walk-in clinic (r = 0.29, P < 0.001) than younger patients. Conclusions Nurse-managed IBD advice lines are proactive services that can address most patient disease-related concerns.
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Affiliation(s)
- Usha Chauhan
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Larry Stitt
- Robarts Clinical Trials, London, Ontario, Canada
| | | | | | - Barbara Currie
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Lisa Westin
- Red Deer Regional Hospital, Red Deer, Alberta, Canada
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Yang YX, Zhang L, Zhao YY, Hao N, Wang BB, Lin YP. Self-efficacy of patients with inflammatory bowel disease: A review. Shijie Huaren Xiaohua Zazhi 2022; 30:425-430. [DOI: 10.11569/wcjd.v30.i10.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic, recurrent, and incurable intestinal disease, which is easy to bring heavy physical and mental damage to patients, and self-efficacy is an important factor affecting physical and mental health. This article reviews the self-efficacy of patients with IBD, focusing on the measurement tools, influencing factors, influence on patients, and improvement measures, in order to provide reference for related research in the future.
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Affiliation(s)
- Ya-Xin Yang
- Nursing Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Li Zhang
- Nursing Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Yue-Yue Zhao
- Nursing Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Na Hao
- Department of Gastroenterology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Bin-Bin Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Yu-Peng Lin
- Nursing Department, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
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11
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Hiremath G, Chapa-Rodriguez A, Katzka DA, Spergel JM, Gold B, Bredenoord AJ, Dellon ES, Huang J, Gupta SK. Transition of care of patients with eosinophilic gastrointestinal diseases: Challenges and opportunities. TRANSLATIONAL SCIENCE OF RARE DISEASES 2022; 6:13-23. [PMID: 35892038 PMCID: PMC9311497 DOI: 10.3233/trd-220054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Eosinophilic gastrointestinal disorders (EGID) are a group of allergen-mediated conditions which are characterized by eosinophilic inflammation affecting one or more parts of the gastrointestinal tract. A disproportionately higher number of EGID patients are diagnosed in the pediatric age group. Given the chronic course of EGIDs and lack of curative therapies at this time, majority of the pediatric EGID patients may require continued care well into their adulthood. However, to date, scant data are available regarding the health care transition (HCT), the transition of care (TC), and the effectiveness of transfer of care EGID patients from pediatric-oriented to adult-oriented providers. Herein, we review the lessons learnt from transfer of care of children with other chronic gastrointestinal and allergic conditions, analyze the current knowledge, potential barriers, the role of various stakeholders in successful transfer of care of EGID patients, propose a conceptual framework for HCT and TC of EGID patients, and identify outcome measures to ensure the quality of progression of care.
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Affiliation(s)
- Girish Hiremath
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Monroe Carroll Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
| | - Adrian Chapa-Rodriguez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David A. Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan M. Spergel
- Division of Allergy-Immunology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Gold
- Children’s Center for Digestive Healthcare, LLC, Atlanta, GA, USA
| | - Albert J. Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Evan S. Dellon
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jeannie Huang
- School of Medicine, University of California, San Diego Rady Children’s Hospital, San Diego, CA, USA
| | - Sandeep K. Gupta
- Medical Director for Research/Community Health Network, Attending Faculty, Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, Indianapolis, IN, USA
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12
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Yao J, Fekadu G, Jiang X, You JHS. Telemonitoring for patients with inflammatory bowel disease amid the COVID-19 pandemic—A cost-effectiveness analysis. PLoS One 2022; 17:e0266464. [PMID: 35390064 PMCID: PMC8989217 DOI: 10.1371/journal.pone.0266464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background and aim
COVID-19 pandemic burdens the healthcare systems, causes healthcare avoidance, and might worsen the outcomes of inflammatory bowel disease (IBD) management. We aimed to estimate the impact of pandemic-related avoidance on outpatient IBD management, and the cost-effectiveness of adding telemonitoring during pandemic from the perspective of Hong Kong public healthcare provider.
Methods
The study was performed by a decision-analytic model to estimate the quality-adjusted life-years (QALYs) and cost of care for IBD patients before and during the pandemic, and to compare the cost and QALYs of adding telemonitoring to standard care (SC-TM) versus standard care alone (SC) for IBD patients during the pandemic. The sources of model inputs included publications (retrieved from literature search) and public data. Sensitivity analyses were conducted to examine the robustness of base-case results.
Results
Standard care with pandemic-related avoidance (versus without avoidance) lost 0.0026 QALYs at higher cost (by USD43). The 10,000 Monte Carlo simulations found standard care with pandemic-related avoidance lost QALYs and incurred higher cost in 100% and 96.82% of the time, respectively. Compared with the SC group, the SC-TM group saved 0.0248 QALYs and reduced cost by USD799. Monte Carlo simulations showed the SC-TM group gained higher QALYs at lower cost in 100% of 10,000 simulations.
Conclusions
Standard care for IBD patients during pandemic with healthcare avoidance appears to worsen treatment outcomes at higher cost and lowered QALYs. The addition of telemonitoring to standard care seems to gain higher QALYs and reduce cost, and is therefore a potential cost-effective strategy for IBD management during the pandemic.
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Affiliation(s)
- Jiaqi Yao
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ginenus Fekadu
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xinchan Jiang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joyce H. S. You
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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13
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Determinants of patient trust in gastroenterology televisits: Results of machine learning analysis. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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14
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Bensted K, Kim C, Freiman J, Hall M, Zekry A. Gastroenterology hospital outpatients report high rates of satisfaction with a Telehealth model of care. J Gastroenterol Hepatol 2022; 37:63-68. [PMID: 34402105 DOI: 10.1111/jgh.15663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022]
Abstract
AIMS This study aimed to capture patient satisfaction with a Telehealth model of care in a tertiary hospital gastroenterology outpatient setting. An in-depth patient questionnaire addressed patients' experience with telephone based consultations, as well as capturing demographic data to predict patients who may benefit from a Telehealth model of care. METHODS Patients aged ≥ 18 years who had a telephone appointment from 1st March 2020 to 1st September 2020 at the St George Hospital and Sutherland Hospital Gastroenterology Clinics in Sydney, Australia, were invited to complete an anonymous online survey detailing their experience. Clinics included general gastroenterology, inflammatory bowel disease, hepatology and swallow disorders. Chi squared analysis was used to investigate if demographic data (age, gender, educational status, English-spoken at home, and presence of IBD or cirrhosis) impacted on a patients rating of care they received. RESULTS 1894 patients were invited to complete with survey, with 302 responses. 294 respondents (88.4%) rated the care they received as "very good" or "good". 254 (84.1%) stated the main reason for attending the clinic was dealt with to their satisfaction. There was no statistical relationship between age, gender, educational status and the rating of care received. 49.7% preferred their telephone appointment, and 63.6% would like the option of a telephone appointment in the future. CONCLUSION Gastroenterology outpatients reported a very high satisfaction with Telehealth, demonstrating a potential for Telehealth to be incorporated into usual care.
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Affiliation(s)
- Karen Bensted
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.,Department of Gastroenterology and Hepatology, The Sutherland Hospital, Sydney, New South Wales, Australia
| | - Christy Kim
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - John Freiman
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Matthew Hall
- Department of Gastroenterology and Hepatology, The Sutherland Hospital, Sydney, New South Wales, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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15
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Costantino A, Bortoluzzi F, Giuffrè M, Vassallo R, Montalbano LM, Monica F, Canova D, Checchin D, Fedeli P, Marmo R, Elli L. Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO). Dig Liver Dis 2021; 53:1221-1227. [PMID: 34312103 DOI: 10.1016/j.dld.2021.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023]
Abstract
The purpose of the present document is to provide detailed information on the correct and optimal use of digital media to ensure continuity of care for gastroenterological patients in everyday clinical practice, in health emergencies and/or when the patient cannot reach the hospital for other reasons. During the recent COVID-19 pandemic, telemedicine has allowed many patients with chronic diseases to access remote care worldwide, proving to be the ideal solution to overcome restrictions and carry out non-urgent routine follow-ups on chronic patients. The COVID-19 pandemic has therefore made organizational and cultural renewal essential for the reorganization of healthcare in order to ensure greater continuity of care with a minimum risk of spreading the virus to users, practitioners and their families. These AIGO recommendations are intended to provide Italian gastroenterologists with a tool to use this method appropriately, in compliance with current legislation, in particular the proper approach and procedures for conducting a remote examination using a video conferencing tool, the so-called televisit. In the near future, telemedicine may contribute to a possible reorganization of healthcare systems, through innovative care models focusing on the citizen and facilitating access to services throughout the entire Country.
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Affiliation(s)
- Andrea Costantino
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Bortoluzzi
- Gastrointestinal Unit, Ospedale dell'Angelo, Venice, Italy; Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy
| | - Mauro Giuffrè
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Italy
| | - Roberto Vassallo
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, Buccheri la Ferla Hospital, Palermo, Italy
| | - Luigi Maria Montalbano
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Fabio Monica
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Digestive Endoscopy, Academic Hospital Cattinara, Trieste, Italy
| | - Daniele Canova
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, San Bortolo Hospital, Vicenza, Italy
| | - Davide Checchin
- Gastrointestinal Unit, Ospedale dell'Angelo, Venice, Italy; Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy
| | - Paolo Fedeli
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, Santo Spirito Hospital, Rome, Italy
| | - Riccardo Marmo
- Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy; Gastroenterology and Endoscopy Unit, PO Polla, ASL Salerno, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Quality Committee, Italian Association Hospital Gastroenterologists and Endoscopists (AIGO), Rome, Italy.
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16
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Bonnaud G, Haennig A, Altwegg R, Caron B, Boivineau L, Zallot C, Gilleta de Saint-Joseph C, Moreau J, Gonzalez F, Reynaud D, Faure P, Aygalenq P, Combis JM, Peyrin-Biroulet L. Real-life pilot study on the impact of the telemedicine platform EasyMICI-MaMICI ® on quality of life and quality of care in patients with inflammatory bowel disease. Scand J Gastroenterol 2021; 56:530-536. [PMID: 33691075 DOI: 10.1080/00365521.2021.1894602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Telemedicine has shown promising results in the follow up of patients with inflammatory bowel disease. This study compared quality of life and disease activity in patients with inflammatory bowel disease monitored using a telemedicine platform versus standard care. METHODS In this prospective multicenter study, patients with active inflammatory bowel disease were randomized to EasyMICI-MaMICI® telemedicine platform or standard care. The main objective was to assess the efficacy of the software platform, as measured by quality of life and quality of care. Secondary outcomes were changes in the use of healthcare resources, and patient satisfaction in the MaMICI group. RESULTS Fifty-four patients were enrolled (November 2017-June 2018); 59.3% had Crohn's disease and 40.7% ulcerative colitis. Forty-two patients received biologics at inclusion. After 12 months, a significant improvement in quality of life was observed with MaMICI versus standard care, with mean (standard deviation) changes from baseline of 14.8 (11.8) vs 6.3 (9.7) in the SIBDQ scores and 18.5 (18.7) vs 2.4 (8.3) in the EuroQol 5 D-3L questionnaire scores (both p ≤ .02). Disease activity was similar in both treatment groups. Use of MaMICI slightly reduced healthcare utilization versus controls (mean gastroenterologist consultations 2.2 vs 4.1; p = .1308). Overall satisfaction with MaMICI was high (mean score 7/10), and 46.2% of remaining patients in the MaMICI group continued to use the platform until 12 months. CONCLUSION Significant improvement in quality of life and overall satisfaction with this telemedicine platform, indicates that further evaluation of EasyMICI-MaMICI in larger numbers of patients with inflammatory bowel disease is warranted.
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Affiliation(s)
| | | | - Romain Altwegg
- Department of Gastroenterology, Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Lucile Boivineau
- Department of Gastroenterology, Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Camille Zallot
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | | | - Jacques Moreau
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Florent Gonzalez
- Department of Gastroenterology, Grand-Sud Polyclinic, Nîmes, France
| | | | - Patrick Faure
- Department of Hepato-Gastroenterology, Pasteur Clinic, Toulouse, France
| | | | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
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17
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D’Amico F, Netter P, Baumann C, Veltin M, Zallot C, Aimone-Gastin I, Danese S, Peyrin-Biroulet L. Setting up a Virtual Calprotectin Clinic in Inflammatory Bowel Diseases: Literature Review and Nancy Experience. J Clin Med 2020; 9:jcm9092697. [PMID: 32825383 PMCID: PMC7563857 DOI: 10.3390/jcm9092697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Technological progress, including virtual clinics, web or smartphone-based applications, and assessment of fecal calprotectin (FC) at home has favored the implementation of treat to target strategies for patients with inflammatory bowel diseases (IBD). Although these innovations are promising and have been associated with a significant reduction in health costs, their application in clinical practice is limited. Here, we summarize the most recent literature on virtual clinics and available FC home tests. In addition, we report the experience of IBD patients monitored through the IBDoc® test at the Nancy University Hospital, focusing on usability testing and patient’s satisfaction. This pilot experience shows that a virtual calprotectin clinic doubles adherence rate to FC in IBD patients. This finding is especially clinically relevant in the post-coronavirus disease 2019 (COVID-19) pandemic era, with an increasing use of e-health.
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Affiliation(s)
- Ferdinando D’Amico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (F.D.); (S.D.)
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France; (M.V.); (C.Z.)
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, 54000 Nancy, France;
| | - Cedric Baumann
- Clinical Research Support Facility, Methodological and Statistical Unit, University Hospital of Nancy, 54000 Nancy, France;
| | - Muriel Veltin
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France; (M.V.); (C.Z.)
| | - Camille Zallot
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France; (M.V.); (C.Z.)
| | - Isabelle Aimone-Gastin
- Department of Biochemistry-Molecular Biology-Nutrition, Nancy University Hospital, 54000 Nancy, France;
- Inserm UMR_S1256 N-GERE, Nutrition-Genetics-Environmental Risk Exposure, University Hospital of Nancy, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (F.D.); (S.D.)
- IBD center, Department of Gastroenterology, Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France; (M.V.); (C.Z.)
- Correspondence: ; Tel.: +33-383-153661; Fax: +33-383-153633
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18
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Coenen S, Nijns E, Weyts E, Geens P, Van den Bosch B, Vermeire S, Ferrante M, Vanhaecht K, Van Assche G. Development and feasibility of a telemonitoring tool with full integration in the electronic medical record: a proof of concept study for patients with inflammatory bowel disease in remission on biological therapy. Scand J Gastroenterol 2020; 55:287-293. [PMID: 32180470 DOI: 10.1080/00365521.2020.1735506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: Telemonitoring can be implemented to enhance disease monitoring and ultimately reduce the number of outpatient visits and associated costs. We developed an in house IBD mobile app and established a proof of concept study to demonstrate the effectiveness and accuracy of the telemonitoring tool for monitoring of disease activity.Methods: An IBD mobile app was designed through close collaboration between the Information Technology and Gastroenterology department of University Hospitals of Leuven. The study was proposed to all patients in remission under stable biological therapy visiting the outpatient clinic. During one-year follow-up, patients completed weekly and monthly questionnaires on their mobile device or on a website. Entered data were directly sent to the electronic medical record. Predefined red flags or alerts, generated by the answers to the questionnaires, were monitored daily.Results: The pilot study in 45 patients demonstrated accurate monitoring of disease activity with fast intervention during flares. During the 12-months follow-up period, an alert for disease activity was generated for 9 different patients out of 1296 completions of the questionnaire. Symptoms resolved spontaneously in 8 patients. One patient reported consecutive PRO-2 increase, endoscopy confirmed an IBD flare and therapy was switched. For the remaining 36 included patients, no alerts indicating disease activity increase were reported. Median compliance to all weekly and monthly questionnaires during 1 year was 52% (IQR: 24-91).Conclusions: We developed the mynexuzhealth IBD app with full integration in the electronic medical record. The app enabled continuous remote monitoring and showed accurate detection of flares.
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Affiliation(s)
- Sofie Coenen
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Egon Nijns
- Information Technology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ellen Weyts
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Patricia Geens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Bart Van den Bosch
- Information Technology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals of Leuven, Leuven, Belgium
| | - Gert Van Assche
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
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19
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Schliep M, Chudy-Onwugaje K, Abutaleb A, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada S, Russman K, Horst S, Beaulieu D, Quinn C, Jambaulikar G, Cross RK. TELEmedicine for Patients With Inflammatory Bowel Disease (TELE-IBD) Does Not Improve Depressive Symptoms or General Quality of Life Compared With Standard Care at Tertiary Referral Centers. CROHN'S & COLITIS 360 2020; 2:otaa002. [PMID: 32201859 PMCID: PMC7067223 DOI: 10.1093/crocol/otaa002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Depression is common in patients with inflammatory bowel disease (IBD) and contributes to poor quality of life (QoL). The use of information technology for the remote management of patients with IBD is growing, but little is known about its impact on depressive symptoms (DS) and QoL. We aimed to evaluate the impact of telemedicine on DS and generic QoL in IBD patients. METHODS We analyzed data from the Telemedicine for Patients with IBD (TELE-IBD) study. During this 12-month clinical trial, patients were randomized to receive text message-based telemedicine weekly (TELE-IBD W), every other week (TELE-IBD EOW), or to standard care. Depressive symptoms and QoL were assessed over time with the Mental Health Inventory 5 (MHI-5) and the Short Form 12 (SF-12), respectively. We compared the change in MHI-5 and SF-12 (with separate physical (PCS) and mental component summary (MCS) scores) between the study arms. RESULTS A total of 217 participants were included in this analysis. After 1 year, there was no significant difference in the change in MHI-5 (TELE-IBD W +3.0 vs TELE-IBD EOW +0.7 vs standard care +3.4; P = 0.70), MCS (TELE-IBD W +1.4 vs TELE-IBD EOW +1.0 vs standard care +2.5; P = 0.89), and PCS scores (TELE-IBD W +0.4 vs TELE-IBD EOW +0.6 vs standard care +3.7; P = 0.06) between the groups. CONCLUSIONS Text message-based telemedicine does not improve DS or QoL when compared with standard care in IBD patients treated at tertiary referral centers. Further studies are needed to determine whether telemedicine improves DS or QoL in settings with few resources.
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Affiliation(s)
- Matthew Schliep
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kenechukwu Chudy-Onwugaje
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ameer Abutaleb
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Ohio, USA
| | - David A Schwartz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - Leyla Ghazi
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Seema A Patil
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Sandra Quezada
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Katharine Russman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Sara Horst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Dawn Beaulieu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Charlene Quinn
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - Guruprasad Jambaulikar
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA,Address correspondence to: Raymond K. Cross, MD, MS, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201, Phone: 410-706-3387, Fax: 410-706-4430,
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Bilgrami Z, Abutaleb A, Chudy-Onwugaje K, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada SM, Russman KM, Quinn CC, Jambaulikar G, Beaulieu DB, Horst S, Cross RK. Effect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy. Dig Dis Sci 2020; 65:96-103. [PMID: 30604373 PMCID: PMC7883399 DOI: 10.1007/s10620-018-5433-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Limitations in inflammatory bowel disease (IBD) care necessitate greater patient activation and self-efficacy, measures associated with positive health outcomes. METHODS We assessed change in patient activation and general self-efficacy from baseline to 12 months through our TELEmedicine for IBD trial, a multicenter, randomized controlled trial consisting of a web-based monitoring system that interacts with participants via text messaging. A total of 222 adults with IBD who had experienced an IBD flare within 2 years prior to the trial were randomized into either a control arm that received standard care (SC) or an intervention arm that completed self-testing through the TELE-IBD system every other week (EOW) or weekly (W). RESULTS Changes in self-efficacy scores were not significantly different between control and experimental groups. Patient activation scores were significantly different between standard care and the TELE-IBD EOW group only (p = 0.03). CONCLUSIONS Use of remote monitoring did not improve self-efficacy or patient activation compared to routine care.
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Affiliation(s)
- Zaid Bilgrami
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Ameer Abutaleb
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Kenechukwu Chudy-Onwugaje
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Patricia Langenberg
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Miguel Regueiro
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - J Kathleen Tracy
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Leyla Ghazi
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Seema A Patil
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Sandra M Quezada
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Katharine M Russman
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Charlene C Quinn
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | | | - Dawn B Beaulieu
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sara Horst
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Raymond K Cross
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA.
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Yin AL, Hachuel D, Pollak JP, Scherl EJ, Estrin D. Digital Health Apps in the Clinical Care of Inflammatory Bowel Disease: Scoping Review. J Med Internet Res 2019; 21:e14630. [PMID: 31429410 PMCID: PMC6718080 DOI: 10.2196/14630] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Digital health is poised to transform health care and redefine personalized health. As Internet and mobile phone usage increases, as technology develops new ways to collect data, and as clinical guidelines change, all areas of medicine face new challenges and opportunities. Inflammatory bowel disease (IBD) is one of many chronic diseases that may benefit from these advances in digital health. This review intends to lay a foundation for clinicians and technologists to understand future directions and opportunities together. OBJECTIVE This review covers mobile health apps that have been used in IBD, how they have fit into a clinical care framework, and the challenges that clinicians and technologists face in approaching future opportunities. METHODS We searched PubMed, Scopus, and ClinicalTrials.gov to identify mobile apps that have been studied and were published in the literature from January 1, 2010, to April 19, 2019. The search terms were ("mobile health" OR "eHealth" OR "digital health" OR "smart phone" OR "mobile app" OR "mobile applications" OR "mHealth" OR "smartphones") AND ("IBD" OR "Inflammatory bowel disease" OR "Crohn's Disease" (CD) OR "Ulcerative Colitis" (UC) OR "UC" OR "CD"), followed by further analysis of citations from the results. We searched the Apple iTunes app store to identify a limited selection of commercial apps to include for discussion. RESULTS A total of 68 articles met the inclusion criteria. A total of 11 digital health apps were identified in the literature and 4 commercial apps were selected to be described in this review. While most apps have some educational component, the majority of apps focus on eliciting patient-reported outcomes related to disease activity, and a few are for treatment management. Significant benefits have been seen in trials relating to education, quality of life, quality of care, treatment adherence, and medication management. No studies have reported a negative impact on any of the above. There are mixed results in terms of effects on office visits and follow-up. CONCLUSIONS While studies have shown that digital health can fit into, complement, and improve the standard clinical care of patients with IBD, there is a need for further validation and improvement, from both a clinical and patient perspective. Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge. New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses.
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Affiliation(s)
- Andrew Lukas Yin
- Medical College, Weill Cornell Medicine, New York, NY, United States
- Cornell Tech, New York, NY, United States
| | - David Hachuel
- Cornell Tech, New York, NY, United States
- augGI Technologies, New York, NY, United States
| | | | - Ellen J Scherl
- Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medicine, New York, NY, United States
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Puolanne AM, Kolho KL, Alfthan H, Färkkilä M. Is home monitoring of inflammatory bowel disease feasible? A randomized controlled study. Scand J Gastroenterol 2019; 54:849-854. [PMID: 31264494 DOI: 10.1080/00365521.2019.1618910] [Citation(s) in RCA: 12] [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
Objectives: The aim of this prospective study was to evaluate the home monitoring with a rapid fecal calprotectin test combined with a symptom questionnaire in patients with colonic IBD in real-life setting. Methods: We randomized 180 patients with colonic IBD in a study or a control group. The home monitoring patients performed the fecal calprotectin test and filled in a symptom questionnaire every second month and in cases with increasing symptoms. The control patients filled in the symptom questionnaire at baseline and at 6 and 12 months as well as for the appointment at the outpatient clinic. The study duration was 12 months. Results: The patient adherence to the self-monitoring program was low. Patients with a higher disease burden were more adherent than patients with better health-related quality of life, but otherwise, there were no significant factors predicting the adherence. The home monitoring patients had fewer contacts with the outpatient clinic, but otherwise, the disease course between the home monitoring and the control group were similar. Conclusions: The self-monitoring of IBD activity with a combination of a rapid fecal calprotectin home test and a symptom questionnaire provides an option for individualized care for IBD patients. However, adherence to the self-monitoring program remains a challenge.
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Affiliation(s)
- Anna-Maija Puolanne
- Clinic of Gastroenterology, Helsinki University Hospital, Jorvi Hospital , Espoo , Finland
| | - Kaija-Leena Kolho
- University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,Tampere University, Tampere University Hospital , Tampere , Finland
| | - Henrik Alfthan
- Department of Clinical Chemistry, University of Helsinki , Helsinki , Finland
| | - Martti Färkkilä
- Department of Medicine, Division of Gastroenterology, Helsinki University Hospital , Helsinki , Finland
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Quinn CC, Chard S, Roth EG, Eckert JK, Russman KM, Cross RK. The Telemedicine for Patients With Inflammatory Bowel Disease (TELE-IBD) Clinical Trial: Qualitative Assessment of Participants' Perceptions. J Med Internet Res 2019; 21:e14165. [PMID: 31162128 PMCID: PMC6746080 DOI: 10.2196/14165] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/01/2019] [Accepted: 05/16/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), comprising Crohn disease and ulcerative colitis, affects 1 to 3 million people in the United States. Telemedicine has shown promise in IBD. The objective of this study, telemedicine for patients with IBD (TELE-IBD), was to compare disease activity and quality of life (QoL) in a 1-year randomized clinical trial of IBD patients receiving telemedicine versus standard care. Treatment groups experienced improvements in disease activity and QoL, but there were no significant differences between groups. Study adherence to the text-based intervention was less than 80%, the targeted goal. OBJECTIVE To understand adherence to remote monitoring, the goal of this qualitative assessment was to obtain TELE-IBD trial participants' perceptions, including their recommendations for future monitoring. METHODS In this study, patients attending 3 tertiary referral centers with worsening IBD symptoms in the previous 2 years were eligible for randomization to remote monitoring via SMS text messages (short message service, SMS) every other week, weekly, or standard care. Participants (n=348) were evenly enrolled in the treatment groups, and 259 (74.4%) completed the study. For this study, a purposive sample of adherent (N=15) and nonadherent (N=14) patients was drawn from the TELE-IBD trial population. Adherence was defined as the completion of 80% (278/348) or more of the weekly or every other week self-assessments. Semistructured interviews conducted by phone surveyed (1) the strengths and benefits of TELE-IBD, (2) challenges associated with using TELE-IBD, and (3) how to improve the TELE-IBD intervention. Interviews were recorded, professionally transcribed, and coded based on a priori concepts and emergent themes with the aid of ATLAS.ti, version.7 qualitative data analysis software. RESULTS Participants' discussions centered on 3 elements of the intervention: (1) self-assessment questions, (2) action plans, and (3) educational messages. Participants also commented on text-based platform, depression and adherence, TELE-IBD system in place of office visit, and their recommendations for future TELE-IBD systems. Adherent and nonadherent participants prefer a flexible system that is personalized, including targeted education messages, and they perceive the intervention as effective in facilitating IBD self-management. CONCLUSIONS Participants identified clear benefits to the TELE-IBD system, including obtaining a better understanding of the disease process, monitoring their symptoms, and feeling connected to their health care provider. Participants' perceptions obtained in this qualitative study will assist in improving the TELE-IBD system to be more responsive to patients with IBD.
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Affiliation(s)
- Charlene Connolly Quinn
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD, United States
| | - Sarah Chard
- University of Maryland Baltimore County, Department of Sociology, Anthropology, and Health Administration and Policy, Baltimore, MD, United States
| | - Erin G Roth
- University of Maryland Baltimore County, Department of Sociology, Anthropology, and Health Administration and Policy, Baltimore, MD, United States
| | - J Kevin Eckert
- University of Maryland Baltimore County, Department of Sociology, Anthropology, and Health Administration and Policy, Baltimore, MD, United States
| | - Katharine M Russman
- University of Maryland School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - Raymond K Cross
- University of Maryland School of Medicine, Department of Medicine, Baltimore, MD, United States
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A Randomized Controlled Trial of TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD). Am J Gastroenterol 2019; 114:472-482. [PMID: 30410041 DOI: 10.1038/s41395-018-0272-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Telemedicine has shown promise in inflammatory bowel disease (IBD). The objective of this study was to compare disease activity and quality of life (QoL) in a 1-year randomized trial of IBD patients receiving telemedicine vs. standard care. METHODS Patients with worsening symptoms in the prior 2 years were eligible for randomization to telemedicine (monitoring via texts EOW or weekly) or standard care. The primary outcomes were the differences in change in disease activity and QoL between the groups; change in healthcare utilization among groups was a secondary aim. RESULTS 348 participants were enrolled (117 control group, 115 TELE-IBD EOW, and 116 TELE-IBD weekly). 259 (74.4%) completed the study. Age was 38.9 ± 12.3 years, 56.6% were women, 91.9% were Caucasian, 67.9% had Crohn's disease (CD) and 42.5% had active disease at baseline. In CD, all groups experienced a decrease in disease activity (control -5.2 ± 5.0 to 3.7 ± 3.6, TELE-IBD EOW 4.7 ± 4.1 to 4.2 ± 3.9, and TELE-IBD weekly 4.2 ± 4.2 to 3.2 ± 3.4, p < 0.0001 for each of the groups) In UC, only controls had a significant decrease in disease activity (control 2.9 ± 3.1 to 1.4 ± 1.4, p = 0.01, TELE-IBD EOW 2.7 ± 3.1 to 1.7 ± 1.9, p = 0.35, and TELE-IBD Weekly 2.5 ± 2.5 to 2.0 ± 1.8, p = 0.31). QoL increased in all groups; the increase was significant only in TELE-IBD EOW (control 168.1 ± 34.0 to 179.3 ± 28.2, p = 0.06, TELE-IBD EOW 172.3 ± 33.1 to 181.5 ± 28.2, p = 0.03, and TELE-IBD Weekly 172.3 ± 34.5 to 179.2 ± 32.8, p = 0.10). Unadjusted and adjusted changes in disease activity and QoL were not significantly different among groups. Healthcare utilization increased in all groups. TELE-IBD weekly were less likely to have IBD-related hospitalizations and more likely to have non-invasive diagnostic tests and electronic encounters compared to controls; both TELE-IBD groups had decreased non-IBD related hospitalizations and increased telephone calls compared to controls. DISCUSSION Disease activity and QoL, although improved in all participants, were not improved further through use of the TELE-IBD system. TELE-IBD participants experienced a decrease in hospitalizations with an associated increase in non-invasive diagnostic tests, telephone calls and electronic encounters. Research is needed to determine if TELE-IBD can be improved through patient engagement and whether it can decrease healthcare utilization by replacing standard care.
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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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Chudy-Onwugaje K, Abutaleb A, Buchwald A, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada S, Russman K, Horst S, Beaulieu D, Quinn C, Jambaulikar G, Cross RK. Age Modifies the Association Between Depressive Symptoms and Adherence to Self-Testing With Telemedicine in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2648-2654. [PMID: 29846623 PMCID: PMC6262196 DOI: 10.1093/ibd/izy194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Depression is common in patients with inflammatory bowel disease (IBD) and is known to be associated with poor adherence in the usual care setting. In the last decade, there has been an increase in the use of information technology (IT) for the delivery of IBD care, but the association between depressive symptoms (DS) and adherence to self-testing in this context is not known. We aimed to investigate this association among IBD patients managed via a text messaging-based telemedicine system. METHODS This was a prospective study of participants in the 2 intervention arms of the Telemedicine for Patients with IBD (TELE-IBD) trial. Depressive symptoms were measured at baseline, and then participants received periodic text messages to initiate IBD-specific self-testing. Treatment plans were similarly conveyed, and adherence to self-testing was evaluated at the end of 1 year. Regression analyses were performed, and age-stratified models were constructed to evaluate for effect modification. RESULTS Of the 193 study participants, 48% had DS at baseline. Overall, there was no significant association between DS and adherence to self-testing. However, upon stratification by age, adherence increased with depressive symptoms in those that were 40 years and younger (P = 0.02), but there was no association between depressive symptoms and adherence in the older group (P = 0.53). CONCLUSIONS Younger IBD patients with DS have high adherence when managed in a text messaging-based telemedicine program. Telemedicine interventions have the potential to improve health outcomes in this demographic-a group that is often thought to be difficult to manage due to nonadherence.
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Affiliation(s)
| | - Ameer Abutaleb
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Andrea Buchwald
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | - Miguel Regueiro
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David A Schwartz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | - Leyla Ghazi
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Seema A Patil
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Sandra Quezada
- Division of Gastroenterology and Hepatology, Department of Medicine
| | | | - Sara Horst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Dawn Beaulieu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Charlene Quinn
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | | | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine,Address correspondence to: Raymond K. Cross, MD, MS, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201 ()
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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: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [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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Jackson BD, Con D, De Cruz P. Design considerations for an eHealth decision support tool in inflammatory bowel disease self-management. Intern Med J 2018; 48:674-681. [PMID: 29136332 DOI: 10.1111/imj.13677] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/07/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Electronic health (eHealth) decision support tools have the potential to: facilitate inflammatory bowel disease (IBD) self-management, reduce health care utilisation and alleviate the pressure on overburdened outpatient clinics. The purpose of this study was to explore the perspectives of key stakeholders on the potential use of a decision support tool for IBD patients. METHODS A qualitative study using focus group methodology was conducted at a tertiary IBD centre in Melbourne, Australia in February 2015. Key stakeholders, including physicians, nurses and patients, were included in the study. Two independent reviewers undertook inductive coding and generated themes. RESULTS In total, 31 participants were included in the study (including 16 males; 11 physicians; 6 nurses). An eHealth decision support tool was thought to be beneficial to facilitate IBD self-management. Four themes emerged: (i) Framework for the decision support tool - the tool should be an adjunct to current models of care and facilitate shared decision-making and patient engagement; (ii) Target population - stable patients with mild to moderate disease; (iii) Functionalities of the intervention - a web-based platform encompassing patient-reported outcomes, objective markers of disease and clinical algorithms based on international guidelines; and (iv) Design and Implementation - patients should be involved in the design. CONCLUSIONS eHealth interventions are thought to be an important strategy to facilitate self-management for patients with IBD. A multi-stage iterative approach should be adopted in the design and implementation process of eHealth interventions. Patient perspectives need to be sought prior to and throughout the development of an eHealth decision support tools for IBD.
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Affiliation(s)
- Belinda D Jackson
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Danny Con
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia
| | - Peter De Cruz
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
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Abutaleb A, Buchwald A, Chudy-Onwugaje K, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada SM, Russman KM, Quinn CC, Jambaulikar G, Beaulieu DB, Horst S, Cross RK. Inflammatory Bowel Disease Telemedicine Clinical Trial: Impact of Educational Text Messages on Disease-Specific Knowledge Over 1 Year. Inflamm Bowel Dis 2018; 24:2191-2197. [PMID: 29788137 PMCID: PMC7190916 DOI: 10.1093/ibd/izy149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Effective treatments are available for patients with inflammatory bowel disease (IBD); however, suboptimal outcomes occur and are often linked to patients' limited disease knowledge. The aim of this analysis was to determine if delivery of educational messages through a telemedicine system improves IBD knowledge. METHODS TELEmedicine for Patients with IBD (TELE-IBD) was a randomized controlled trial with visits at baseline, 6 months, and 12 months; patient knowledge was a secondary aim of the study. Patients were randomized to receive TELE-IBD every other week (EOW), weekly (TELE-IBD W), or standard of care. Knowledge was assessed at each visit with the Crohn's and Colitis Knowledge (CCKNOW) survey. The primary outcome was change in CCKNOW score over 1 year compared between the TELE-IBD and control groups. RESULTS This analysis included 219 participants. Participants in the TELE-IBD arms had a greater improvement in CCKNOW score compared with standard care (TELE-IBD EOW +2.4 vs standard care +1.8, P = 0.03; TELE-IBD W +2.0 vs standard care +1.8, P = 0.35). Participants with lower baseline CCKNOW scores had a greater change in their score over time (P < 0.01). However, after adjusting for race, site, and baseline knowledge, there was no difference in CCKNOW score change between the control and telemedicine arms. CONCLUSIONS Telemedicine improves IBD-specific knowledge through text messaging, although the improvement is not additive with greater frequency of text messages. However, after adjustment for confounding variables, telemedicine is not superior to education given through standard visits at referral centers. Further research is needed to determine if revised systems with different modes of delivery and/or frequency of messages improve disease knowledge.
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Affiliation(s)
- Ameer Abutaleb
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea Buchwald
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Miguel Regueiro
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Leyla Ghazi
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Seema A Patil
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Dawn B Beaulieu
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sara Horst
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Raymond K Cross
- University of Maryland School of Medicine, Baltimore, Maryland,Address correspondence to: Raymond K. Cross, MD, MS, AGAF, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201 ()
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30
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Kim ES, Lee YJ, Jang BI, Kim KO, Kim EY, Lee HS, Jeon SW, Kwak SG. 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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Habashi P, Bouchard S, Nguyen GC. Transforming Access to Specialist Care for Inflammatory Bowel Disease: The PACE Telemedicine Program. J Can Assoc Gastroenterol 2018; 2:186-194. [PMID: 31616860 PMCID: PMC6785695 DOI: 10.1093/jcag/gwy046] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There are significant geographic disparities in the delivery of IBD healthcare in Ontario which may ultimately impact health outcomes. Telemedicine-based health services may potentially bridge gaps in access to gastroenterologists in remote and underserved areas. Methods We conducted a needs assessment for IBD specialist care in Ontario using health administrative data. As part of a separate initiative to address geographic disparities in access to care, we described the development and implementation of our Promoting Access and Care through Centres of Excellence (PACE) Telemedicine Program. Over the first 18 months, we measured wait times and potential cost savings. Results We found substantial deficiencies in specialist care early in the course of IBD and continuous IBD care in regions where the number of gastroenterologists per capita were low. The PACE Telemedicine Program enabled new IBD consultations within a median time of 17 days (interquartile range [IQR], 7–32 days) and visits for active IBD symptoms with a median time of 8.5 days (IQR, 4–14 days). Forty-five percent of new consultations and 83% of patients with active IBD symptoms were seen within the target wait time of two weeks. Telemedicine services resulted in an estimated cost savings of $47,565 among individuals who qualified for Ontario’s Northern Travel Grant. Conclusions The implementation of telemedicine services for IBD is highly feasible and can reduce wait times to see gastroenterologists that meet nationally recommended targets and can lead to cost savings.
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Affiliation(s)
- Peter Habashi
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada
| | - Shelley Bouchard
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
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Patil SA, Cross RK. Current Landscape of Telemedicine Practice in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:1910-1917. [PMID: 29718218 DOI: 10.1093/ibd/izy113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease (IBD), comprised of Crohn's disease and ulcerative colitis, affects 1.6 million people in the United States. Although effective medical treatments exist to treat the disease, outcomes are still suboptimal. The reasons for poor outcomes vary but include nonadherence to therapy, inadequate monitoring of patients, limited access to IBD specialty care, concurrent psychiatric disease, limited patient knowledge of the disease and treatments, and patient provider discordance. Telemedicine is a candidate intervention that can be used to improve patient outcomes through more frequent monitoring, patient self-management, delivery of education (patient and provider), and to increase access to multidisciplinary IBD care. Telemedicine includes remote monitoring, telehealth, teleconsultation, and teleconferencing. Telemedicine systems have been used in patients with IBD with widespread patient acceptance of the technology. However, early clinical trials demonstrated high attrition rates among intervention patients. In general, use of telemedicine systems have been associated with improved quality of life, improved patient knowledge, and decreased utilization of health care resources. Early studies evaluating telehealth visits report high patient satisfaction, decreased indirect costs to patients, and no decrease in quality of care delivered. Due to widespread access to computers and smart phones among patients, telemedicine will continue to expand in the care of patients with IBD. To optimize use and effectiveness of telemedicine, barriers for use including concerns over increased liability, need for informed consent, licensure restrictions to providing interstate telehealth visits, and cybersecurity need to be addressed.
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Affiliation(s)
- Seema A Patil
- University of Maryland School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, MD
| | - Raymond K Cross
- University of Maryland School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, MD
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Walsh A, Travis S. What's app? Electronic health technology in inflammatory bowel disease. Intest Res 2018; 16:366-373. [PMID: 30090035 PMCID: PMC6077306 DOI: 10.5217/ir.2018.16.3.366] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/30/2022] Open
Abstract
Electronic health (eHealth) data collection is increasingly used in many chronic illnesses, to track pattern of disease. eHealth systems have the potential to revolutionize care. Inflammatory bowel disease (IBD) is a paradigm for such an approach: this is a chronic disease that usually affects young and technologically literate patient population, who are motivated to be involved in their own care. A range of eHealth technologies are available for IBD. This review considers the strengths and weaknesses of 7 platforms that focus on patient-provider interaction. These have been developed in Denmark, United States, the Netherlands, and the United Kingdom, demonstrating an international interest in this form of technology and interaction. Not only do these technologies aim to improve care but they also have the potential to collect large amounts of information. Information includes demographics and patient reported outcomes (symptoms, quality of life), quality of care (steroid use, among other metrics) and outcomes such as hospitalization. These data could inform quality improvement programmes to improve their focus. eHealth technology is also open to machine learning to analyze large data sets, through which personalized algorithms may be developed.
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Affiliation(s)
- Alissa Walsh
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Simon Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
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Helsel BC, Williams JE, Lawson K, Liang J, Markowitz J. Telemedicine and Mobile Health Technology Are Effective in the Management of Digestive Diseases: A Systematic Review. Dig Dis Sci 2018; 63:1392-1408. [PMID: 29663265 DOI: 10.1007/s10620-018-5054-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/31/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mobile applications and interactive websites are an increasingly used method of telemedicine, but their use lacks evidence in digestive diseases. AIM This study aims to explore digestive disease studies that use telemedicine to effectively manage disease activity, help monitor symptoms, improve compliance to the treatment protocol, increase patient satisfaction, and enhance the patient-to-provider communication. METHODS EBSCO, PubMed, and Web of Science databases were searched using Medical Subject Headings and other keywords to identify studies that utilized telemedicine in patients with digestive disease. The PRISMA guidelines were used to identify 20 research articles that had data aligning with 4 common overlapping themes including, patient compliance (n = 13), patient satisfaction (n = 11), disease activity (n = 15), and quality of life (n = 13). The studies focused on digestive diseases including inflammatory bowel disease (n = 7), ulcerative colitis (n = 4), Crohn's Disease (n = 1), irritable bowel syndrome (n = 6), and colorectal cancer (n = 2). RESULTS From the studies included in this systematic review, patient compliance and patient satisfaction ranged between 25.7-100% and 74-100%, respectively. Disease activity, measured by symptom severity scales and physiological biomarkers, showed improvements following telemedicine interventions in several, but not all, studies. Similar to disease activity, general and disease-specific quality of life showed improvements following telemedicine interventions in as little as 12 weeks in some studies. CONCLUSION Telemedicine and mobile health technology may be effective in managing disease activity and improving quality of life in digestive diseases. Future studies should explore both gastrointestinal and gastroesophageal diseases using these types of interventions.
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Affiliation(s)
- Brian C Helsel
- Department of Public Health Sciences, Clemson University, P.O. Box 340745, Clemson, SC, 29634-0745, USA.
| | - Joel E Williams
- Department of Public Health Sciences, Clemson University, P.O. Box 340745, Clemson, SC, 29634-0745, USA
| | - Kristen Lawson
- Department of Nursing, Clemson University, Clemson, SC, USA
| | - Jessica Liang
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan Markowitz
- Department of Pediatric Gastroenterology, Greenville Health System, Greenville, SC, USA
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35
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Heida A, Dijkstra A, Muller Kobold A, Rossen JW, Kindermann A, Kokke F, de Meij T, Norbruis O, Weersma RK, Wessels M, Hummel T, Escher J, van Wering H, Hendriks D, Mearin L, Groen H, Verkade HJ, van Rheenen PF. Efficacy of Home Telemonitoring versus Conventional Follow-up: A Randomized Controlled Trial among Teenagers with Inflammatory Bowel Disease. J Crohns Colitis 2018; 12:432-441. [PMID: 29228230 DOI: 10.1093/ecco-jcc/jjx169] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Conventional follow-up of teenagers with inflammatory bowel diseases [IBD] is done during scheduled outpatient visits regardless of how well the patient feels. We designed a telemonitoring strategy for early recognition of flares and compared its efficacy with conventional follow-up. METHODS We used a multicentre randomized trial in patients aged 10-19 years with IBD in clinical remission at baseline. Participants assigned to telemonitoring received automated alerts to complete a symptom score and send a stool sample for measurement of calprotectin. This resulted in an individual prediction for flare with associated treatment advice and test interval. In conventional follow-up the health check interval was left to the physician's discretion. The primary endpoint was cumulative incidence of disease flares. Secondary endpoints were percentage of participants with a positive change in quality-of-life and cost-effectiveness of the intervention. RESULTS We included 170 participants [84 telemonitoring; 86 conventional follow-up]. At 52 weeks the mean number of face-to-face visits was significantly lower in the telemonitoring group compared to conventional follow-up [3.6 vs 4.3, p < 0.001]. The incidence of flares [33 vs 34%, p = 0.93] and the proportion of participants reporting positive change in quality-of-life [54 vs 44%, p = 0.27] were similar. Mean annual cost-saving was €89 and increased to €360 in those compliant to the protocol. CONCLUSIONS Telemonitoring is as safe as conventional follow-up, and reduces outpatient visits and societal costs. The positive impact on quality-of-life was similar in the two groups. This strategy is attractive for teenagers and families, and health professionals may be interested in using it to keep teenagers who are well out of hospital and ease pressure on overstretched outpatient services. TRIAL REGISTRATION NTR3759 [Netherlands Trial Registry].
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Affiliation(s)
- Anke Heida
- Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, The Netherlands
| | - Alie Dijkstra
- Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, The Netherlands
| | - Anneke Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, The Netherlands
| | - John W Rossen
- Department of Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, The Netherlands
| | - Angelika Kindermann
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital Academic Medical Centre, Meibergdreef, Amsterdam, The Netherlands
| | - Freddy Kokke
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Wilhelmina Children's Hospital, Lundlaan, Utrecht, The Netherlands
| | - Tim de Meij
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, VU Medical Centre, De Boelelaan, Amsterdam, The Netherlands
| | - Obbe Norbruis
- Department of Paediatrics, Isala Clinic, Dokter van Heesweg, Zwolle, The Netherlands
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, The Netherlands
| | - Margreet Wessels
- Department of Paediatrics, Rijnstate Hospital, Wagnerlaan, Arnhem, The Netherlands
| | - Thalia Hummel
- Department of Paediatrics, Medisch Spectrum Twente, Koningsplein, Enschede, The Netherlands
| | - Johanna Escher
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Erasmus Medical Center-Sophia Children's Hospital, Wytemaweg, Rotterdam, The Netherlands
| | - Herbert van Wering
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Amphia Hospital, Langendijk, Breda, The Netherlands
| | - Daniëlle Hendriks
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Juliana Children's Hospital/Haga, Els Borst-Eilersplein, The Hague, The Netherlands
| | - Luisa Mearin
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Leiden University Medical Centre, Albinusdreef, Leiden, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein, The Netherlands
| | - Henkjan J Verkade
- Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, The Netherlands
| | - Patrick F van Rheenen
- Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, The Netherlands
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Park J, Cheon JH, Park Y, Park SJ, Kim TI, Kim WH. Risk Factors and Outcomes of Emergency Room Visits in Intestinal Behçet's Disease. Digestion 2017; 96:231-238. [PMID: 29131059 DOI: 10.1159/000484084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/09/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Intestinal Behçet's disease (BD) is a chronic recurring intestinal vasculitic disorder that can lead to emergency room (ER) visits. We aimed to investigate the independent risk factors associated with intestinal BD-related ER visits. METHODS We retrospectively reviewed 606 patients with intestinal BD registered at the Inflammatory Bowel Disease Clinic of Severance Hospital, Seoul, Korea. RESULTS One hundred eighty-five patients (30.5%) visited the ER at least once (total visits, 510). In multivariate analysis, lower socioeconomic status (hazard ratio [HR] 1.884), higher comorbidity index (HR 1.548), corticosteroid use (HR 1.459), higher C-reactive protein (CRP; HR 1.375), and higher disease activity index for intestinal BD (DAIBD) score (HR 1.013) were independent risk factors. However, older age (HR 0.982), disease duration (HR 0.850), opioid use (HR 0.528), and higher hemoglobin level (HR 0.944) were significantly associated with decreased ER visits. CONCLUSIONS The ER attendance rate of patients with intestinal BD was 30.5%. Lower socioeconomic status, higher comorbidity index, corticosteroid use, higher CRP, and higher DAIBD score were positively associated with ER visits. Older age, disease duration, opioid use, and higher hemoglobin level were significantly associated with decreased ER visits.
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Affiliation(s)
- Jihye Park
- Department of Internal Medicine, Seoul, Republic of Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yehyun Park
- Department of Internal Medicine, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Jung Park
- Department of Internal Medicine, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Il Kim
- Department of Internal Medicine, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Internal Medicine, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Squires SI, Boal AJ, Lamont S, Naismith GD. Implementing a self-management strategy in inflammatory bowel disease (IBD): patient perceptions, clinical outcomes and the impact on service. Frontline Gastroenterol 2017; 8:272-278. [PMID: 29067153 PMCID: PMC5641849 DOI: 10.1136/flgastro-2017-100807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/25/2017] [Accepted: 03/07/2017] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Patient self-management and its service integration is not a new concept but it may be a key component in the long-term sustainability of inflammatory bowel disease (IBD) service provision, when considering growing disease prevalence and limited resources. METHODS The IBD team at the Royal Alexandra and Vale of Leven Hospitals in the Clyde Valley region developed a self-management tool, called the 'flare card'. Patients were asked to complete a questionnaire which reflected their opinion on its viability as a self-management intervention. In addition, its utility in terms of service use over a 10-month period in 2016 was compared with a similar cohort of patients over 10 months in 2015. RESULTS Patients overall felt that the 'flare card' was a viable self-management tool. Positive feedback identified that the intervention could help them aid control over their IBD, improve medication adherence, reduce symptoms and reflected a feeling of patient-centred IBD care. The comparison between 2015 and 2016 service use revealed a significant reduction in IBD and non-IBD service usage, Steroid prescribing and unscheduled IBD care in the flare card supported cohort. CONCLUSIONS IBD services must continue to adapt to changes within the National Health Service bearing in mind long-term sustainability and continued care provision. The 'flare card' goes further in an attempt to optimise Crohn's disease and ulcerative colitis management by harmonising clinician evaluation and patient's self-initiation of therapy and investigation.
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Affiliation(s)
- Seth Ian Squires
- C/O Gastroenterology Department, Royal Alexandra and Vale of Leven Hospitals, Paisley, UK
| | - Allan John Boal
- C/O Gastroenterology Department, Royal Alexandra and Vale of Leven Hospitals, Paisley, UK
| | - Selina Lamont
- C/O Gastroenterology Department, Royal Alexandra and Vale of Leven Hospitals, Paisley, UK
| | - Graham D Naismith
- C/O Gastroenterology Department, Royal Alexandra and Vale of Leven Hospitals, Paisley, UK
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Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) require regular follow-up to manage their care, which requires significant amount of time and out-of-pocket costs. Telemedicine in the form of video virtual visits could serve as an alternative to in-office visits. The aim of this project was to understand if telemedicine can provide high value care (defined as quality/cost) to outpatients with IBD. METHODS Patients who participated in the IBD telemedicine clinic in the second half of 2015 were included. Patient-reported survey data before and after the virtual visit were collected. A retrospective review was performed on the study cohort for quality outcome measures a year before and after starting the telemedicine clinic. Outcomes were analyzed using simple descriptive statistics. Differences in quality outcomes were compared using odds ratios. RESULTS Forty-eight patients were included in the analysis. Most patients travel more than 25 miles each way, take half a day off, and on average incur an additional out-of-pocket cost of $62 for an in-office visit. Most patients (98%) agreed that there was enough time spent with their physician, 91% agreed that they felt like the physician understood their disease state, and 78% reported that they clearly understood the follow-up plan after the visit. Analysis of quality outcome measures did not show any drop in the overall quality of care, after initiating the telemedicine program. CONCLUSIONS Telemedicine offers a low cost and convenient alternative for patients with IBD without compromising quality of care.
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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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White Paper AGA: The Impact of Mental and Psychosocial Factors on the Care of Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2017; 15:986-997. [PMID: 28300693 DOI: 10.1016/j.cgh.2017.02.037] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/09/2017] [Accepted: 02/27/2017] [Indexed: 02/07/2023]
Abstract
Patients with chronic medically complex disorders like inflammatory bowel diseases (BD) often have mental health and psychosocial comorbid conditions. There is growing recognition that factors other than disease pathophysiology impact patients' health and wellbeing. Provision of care that encompasses medical care plus psychosocial, environmental and behavioral interventions to improve health has been termed "whole person care" and may result in achieving highest health value. There now are multiple methods to survey patients and stratify their psychosocial, mental health and environmental risk. Such survey methods are applicable to all types of IBD programs including those at academic medical centers, independent health systems and those based within independent community practice. Once a practice determines that a patient has psychosocial needs, a variety of resources are available for referral or co-management as outlined in this paper. Included in this white paper are examples of psychosocial care that is integrated into IBD practices plus innovative methods that provide remote patient management.
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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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Abstract
BACKGROUND Tight control of disease activity, medication side effects, and adherence are crucial to prevent disease complications and improve quality of life in patients with inflammatory bowel disease (IBD). The chronic nature and increasing incidence of IBD demand health care innovations to guarantee future high-quality care. Previous research proved that integrated care by telemedicine can improve outcomes of chronic diseases. Currently available IBD telemedicine tools focus on specific patient subgroups. Therefore, we aimed to (1) develop a telemedicine system suitable for all patients with IBD in everyday practice and (2) to test this system's feasibility. METHODS With a structured iterative process between patients, dietitians, IBD nurse-specialists, and gastroenterologists, myIBDcoach was developed. During 3 months, myIBDcoach's feasibility was tested by 30 consecutive outpatients with IBD of 3 hospitals. Thereafter, patients and health care providers completed a questionnaire covering satisfaction, accessibility, and experiences with myIBDcoach. RESULTS MyIBDcoach enables continuous home-monitoring of patients with IBD and optimizes disease knowledge and communication between patients and health care providers. Besides disease activity, medication adherence, and side effects, myIBDcoach monitors malnutrition, smoking, quality of life, fatigue, life-events, work participation, stress, and anxiety and depression and provides e-learnings for patient empowerment. Patients graded the system with a mean of 7.8 of 10, and 93% would recommend myIBDcoach to other patients. CONCLUSIONS We developed myIBDcoach, which enables integrated care for all patients with IBD, regardless of disease severity or medication use. The feasibility study showed high satisfaction and compliance of patients and health care providers. To study myIBDcoach's efficacy, a multicenter randomized controlled trial has been initiated.
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Cross RK, Kane S. Integration of Telemedicine Into Clinical Gastroenterology and Hepatology Practice. Clin Gastroenterol Hepatol 2017; 15:175-181. [PMID: 27989663 DOI: 10.1016/j.cgh.2016.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, Baltimore, Maryland.
| | - Sunanda Kane
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Paul DL, McDaniel RR. Influences on teleconsultation project utilization rates: the role of dominant logic. BMC Med Inform Decis Mak 2016; 16:155. [PMID: 27931219 PMCID: PMC5146905 DOI: 10.1186/s12911-016-0392-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/22/2016] [Indexed: 01/18/2023] Open
Abstract
Background This research analyzes teleconsultation from both a mechanistic and complex adaptive system (CAS) dominant logic in order to further understand the influence of dominant logic on utilization rates of teleconsultation projects. In both dominant logics, the objective of teleconsultation projects is to increase access to and quality of healthcare delivery in a cost efficient manner. A mechanistic dominant logic perceives teleconsultation as closely resembling the traditional service delivery model, while a CAS dominant logic focuses on the system’s emergent behavior of learning resulting from the relationships and interactions of participating healthcare providers. Methods Qualitative case studies of 17 teleconsultation projects that were part of four health sciences center (HSC) based telemedicine networks was utilized. Data were collected at two points in time approximately 10 years apart. Semi-structured interviews of 85 key informants (clinicians, administrators, and IT professionals) involved in teleconsultation projects were the primary data collection method. Results The findings indicated that the emergent behavior of effective and sustainable teleconsultation projects differed significantly from what was anticipated in a mechanistic dominant logic. Teleconsultation projects whose emergent behavior focused on continuous learning enabled remote site generalists to manage and treat more complex cases and healthcare problems on their own without having to refer to HSC specialists for assistance. In teleconsultation projects that continued to be effectively utilized, participant roles evolved and were expanded. Further, technology requirements for teleconsultation projects whose emergent behavior was learning did not need to be terribly sophisticated. Conclusions When a teleconsultation project is designed with a mechanistic dominant logic, it is less likely to be sustained, whereas a teleconsultation project designed with a CAS dominant logic is more likely to be sustained. Consistent with a CAS dominant logic, teleconsultation projects that continued to be utilized involved participants taking on new roles and continuously learning. This continuous learning enabled remote site generalists to better handle the constantly changing nature of the problems faced. A CAS dominant logic provides a theoretical framework which explains why the teleconsultation literature about the role of technology, which is based on a mechanistic dominate logic, does not have adequate explanatory power. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0392-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David L Paul
- Department of Business Information and Analytics, Daniels College of Business, University of Denver, Denver, CO, USA.
| | - Reuben R McDaniel
- McCombs School of Business, The University of Texas at Austin, Austin, TX, USA
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Van Deen WK, van der Meulen-de Jong AE, Parekh NK, Kane E, Zand A, DiNicola CA, Hall L, Inserra EK, Choi JM, Ha CY, Esrailian E, van Oijen MGH, Hommes DW. Development and Validation of an Inflammatory Bowel Diseases Monitoring Index for Use With Mobile Health Technologies. Clin Gastroenterol Hepatol 2016; 14:1742-1750.e7. [PMID: 26598228 DOI: 10.1016/j.cgh.2015.10.035] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Mobile health technologies are advancing rapidly as smartphone use increases. Patients with inflammatory bowel disease (IBD) might be managed remotely through smartphone applications, but no tools are yet available. We tested the ability of an IBD monitoring tool, which can be used with mobile technologies, to assess disease activity in patients with Crohn's disease (CD) or ulcerative colitis (UC). METHODS We performed a prospective observational study to develop and validate a mobile health index for CD and UC, which monitors IBD disease activity using patient-reported outcomes. We collected data from disease-specific questionnaires completed by 110 patients with CD and 109 with UC who visited the University of California, Los Angeles, Center for IBD from May 2013 through January 2014. Patient-reported outcomes were compared with clinical disease activity index scores to identify factors associated with disease activity. Index scores were validated in 301 patients with CD and 265 with UC who visited 3 tertiary IBD referral centers (in California or Europe) from April 2014 through March 2015. RESULTS We assessed activity of CD based on liquid stool frequency, abdominal pain, patient well-being, and patient-assessed disease control, and activity of UC based on stool frequency, abdominal pain, rectal bleeding, and patient-assessed disease control. The indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.90 in patients with CD and 0.91 in patients with UC. They identified endoscopic activity with area under the receiver operating characteristic values of 0.63 in patients with CD and 0.82 in patients with UC. Both scoring systems responded to changes in disease activity (P < .003). The intraclass correlation coefficient for test-retest reliability was 0.94 for CD and for UC. CONCLUSIONS We developed and validated a scoring system to monitor disease activity in patients with CD and UC that can be used with mobile technologies. The indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.9 or higher in patients with CD or UC, and endoscopic activity in patients with UC but not CD.
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Affiliation(s)
- Welmoed K Van Deen
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Nimisha K Parekh
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Ellen Kane
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Aria Zand
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Courtney A DiNicola
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Laurin Hall
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Elizabeth K Inserra
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jennifer M Choi
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Christina Y Ha
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Eric Esrailian
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Martijn G H van Oijen
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands
| | - Daniel W Hommes
- UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Jackson BD, Gray K, Knowles SR, De Cruz P. EHealth Technologies in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis 2016; 10:1103-21. [PMID: 26928960 DOI: 10.1093/ecco-jcc/jjw059] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/18/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Electronic-health technologies (eHealth) such as Web-based interventions, virtual clinics, smart-phone applications, and telemedicine are being used to manage patients with inflammatory bowel disease (IBD). We aimed to: (1) Evaluate the impact of eHealth technologies on conventional clinical indices and patient-reported outcome measures (PROs) in IBD; (2) assess the effectiveness, cost-effectiveness and feasibility of using eHealth technologies to facilitate the self-management of individuals with IBD, and; (3) provide recommendations for their design and optimal use for patient care. METHODS Relevant publications were identified via a literature search, and 17 publications were selected based on predefined quality parameters. RESULTS Six randomized controlled trials and nine observational studies utilizing eHealth technologies in IBD were identified. Compared with standard outpatient-led care, eHealth technologies have led to improvements in: Relapse duration [(n = 1) 18 days vs 77 days, p < 0.001]; disease activity (n = 2); short-term medication adherence (n = 3); quality of life (n = 4); IBD knowledge (n = 2); healthcare costs (n = 4); the number of acute visits to the outpatient clinic due to IBD symptoms (n = 1), and; facilitating the remote management of up to 20% of an IBD cohort (n = 2). Methodological shortcomings of eHealth studies include heterogeneity of outcome measures, lack of clinician/patient input, lack of validation against conventional clinical indices and PROs, and limited cost-benefit analyses. CONCLUSIONS EHealth technologies have the potential for promoting self-management and reducing the impact of the growing burden of IBD on health care resource utilization. A theoretical framework should be applied to the development, implementation, and evaluation of eHealth interventions.
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Affiliation(s)
- Belinda D Jackson
- Department of Gastroenterology, The Austin Hospital, Melbourne Australia Department of Medicine, University of Melbourne, Austin Academic Centre, Melbourne, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre (HABIC), University of Melbourne, Melbourne, Australia
| | - Simon R Knowles
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia Department of Mental Health, St Vincent's Hospital, Melbourne, Australia Department of Psychiatry, The University of Melbourne, Melbourne, Australia Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter De Cruz
- Department of Gastroenterology, The Austin Hospital, Melbourne Australia Department of Medicine, University of Melbourne, Austin Academic Centre, Melbourne, Australia
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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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Gurupur V, Shettian K, Xu P, Hines S, Desselles M, Dhawan M, Wan TT, Raffenaud A, Anderson L. Identifying the readiness of patients in implementing telemedicine in northern Louisiana for an oncology practice. Health Informatics J 2016; 23:181-196. [PMID: 27102886 DOI: 10.1177/1460458216639740] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study identified the readiness factors that may create challenges in the use of telemedicine among patients in northern Louisiana with cancer. To identify these readiness factors, the team of investigators developed 19 survey questions that were provided to the patients or to their caregivers. The team collected responses from 147 respondents from rural and urban residential backgrounds. These responses were used to identify the individuals' readiness for utilising telemedicine through factor analysis, Cronbach's alpha reliability test, analysis of variance and ordinary least squares regression. The analysis results indicated that the favourable factor (positive readiness item) had a mean value of 3.47, whereas the unfavourable factor (negative readiness item) had a mean value of 2.76. Cronbach's alpha reliability test provided an alpha value of 0.79. Overall, our study indicated a positive attitude towards the use of telemedicine in northern Louisiana.
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Con D, De Cruz P. Mobile Phone Apps for Inflammatory Bowel Disease Self-Management: A Systematic Assessment of Content and Tools. JMIR Mhealth Uhealth 2016; 4:e13. [PMID: 26831935 PMCID: PMC4754530 DOI: 10.2196/mhealth.4874] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/24/2015] [Accepted: 10/07/2015] [Indexed: 12/16/2022] Open
Abstract
Background The rising incidence of inflammatory bowel disease (IBD) over the past decade has resulted in increased health care utilization and longer IBD outpatient waiting lists. Self-management is recognized as an important aspect of chronic disease management but its application to IBD has been limited. The age of IBD onset in a majority of patients is in their 20s to 30s. Mobile phone apps are a technology familiar to young adults and represent an opportunity to explore self-management as a new model of health care delivery for IBD. Objective The aim of this study was to explore the content and tools of existing IBD apps to identify functionalities that may facilitate patient self-management. Methods We systematically assessed apps targeted at IBD patients via searches of Google (Android devices) and Apple (iOS devices) app stores with pre-defined inclusion and exclusion criteria. Apps were assessed for specific functionalities; presence of professional medical involvement; consistency with international IBD guidelines based on “complete,” “partial,” or “absent” coverage of consensus statements derived from the European Crohn’s and Colitis Organisation, American College of Gastroenterology, and the Gastroenterology Society of Australia; comprehensiveness of data that could be entered; and average pricing. Results Of the 238 apps screened, 26 apps were assessed, including 10 available on Android platforms, 8 on iOS platforms, and 8 on both. Over half (14/26, 54%) of the apps had diary functionalities; over a third (10/26, 39%) provided health information about IBD. None of the apps offered decision support to facilitate the self-initiation of medical therapy. Five of 26 (19%) had professional medical involvement in their design. Apps demonstrated “complete” coverage of only 38% of the international consensus statements explored. The average price of the apps was AUD$1.37. Conclusions Apps may provide a useful adjunct to the management of IBD patients. However, a majority of current apps suffer from a lack of professional medical involvement and limited coverage of international consensus guidelines. Future studies and app design for IBD should include professional medical involvement, evidence-based guidelines, and functionalities with decision support that are specifically tailored to patient self-management.
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Affiliation(s)
- Danny Con
- Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
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