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Dimidi E, McArthur AJ, White R, Whelan K, Lomer MCE. Optimizing educational methods for the low FODMAP diet in disorders of gut-brain interaction: A feasibility randomized controlled trial. Neurogastroenterol Motil 2023; 35:e14640. [PMID: 37480191 DOI: 10.1111/nmo.14640] [Citation(s) in RCA: 2] [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] [Received: 01/16/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND A diet low in fermentable oligo-saccharides, di-saccharides, mono-saccharides and polyols (low FODMAP diet) is complex and clinical effectiveness is achieved with dietitian-led education, although dietitian availability in clinical practice varies. This study aimed to assess the feasibility of undertaking a trial to investigate the clinical and cost-effectiveness of different education delivery methods of the low FODMAP diet in patients with disorders of gut-brain interaction (DGBI). METHODS In this feasibility randomized controlled trial, patients with DGBI requiring the low FODMAP diet were randomized to receive one of the following education delivery methods: booklet, app, or dietitian. Recruitment and retention rates, acceptability, symptoms, stool output, quality of life, and dietary intake were assessed. KEY RESULTS Fifty-one patients were randomized with a recruitment rate of 2.4 patients/month and retention of 48 of 51 (94%). Nobody in the booklet group strongly agreed that this education delivery method enabled them to self-manage symptoms without further support, compared to 7 of 14 (50%) in the dietitian group (p = 0.013). More patients reported adequate relief of symptoms in the dietitian group (12, 80%) compared with the booklet group (7, 39%; p = 0.026), but not when compared to the app group (10, 63%, p > 0.05). There was a greater decrease in the IBS-SSS score in the dietitian group (mean -153, SD 90) compared with the booklet group (mean -90, SD 56; p = 0.043), but not when compared with the app group (mean -120, SD 62; p = 0.595). CONCLUSIONS & INFERENCES Booklets were the least acceptable education delivery methods. Dietitian-led consultations led to high levels of clinical effectiveness, followed by the app, while the dietitian was superior to booklets alone. However, an adequately powered clinical trial is needed to confirm clinical effectiveness of these education delivery methods.
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Affiliation(s)
- Eirini Dimidi
- Department of Nutritional Sciences, King's College London, London, UK
| | | | - Rachel White
- Department of Nutritional Sciences, King's College London, London, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Miranda C E Lomer
- Department of Nutritional Sciences, King's College London, London, UK
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Gould MJ, Lin C, Walsh CM. A Systematic Assessment of the Quality of Smartphone Applications for Gastroesophageal Reflux Disease. GASTRO HEP ADVANCES 2023; 2:733-742. [PMID: 39129878 PMCID: PMC11308438 DOI: 10.1016/j.gastha.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/02/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims Smartphone applications aimed at patients with gastroesophageal reflux disease (GERD) have been downloaded more than 100,000 times, yet no systematic assessment of their quality has been completed. This study aimed to objectively assess the quality of GERD smartphone applications for patient education and disease management. Methods The Apple App Store and Google Play Store were systematically searched for relevant applications. Two independent reviewers performed the application screening and eligibility assessment. Included applications were graded using the validated Mobile Application Rating Scale, which encompasses 4 domains (engagement, functionality, aesthetics, and information) as well as an overall application quality score. The associations between overall application quality, user ratings and download numbers were evaluated. Results Of the 4816 unique applications identified, 46 met inclusion criteria (patient education = 37, disease management = 9). Mean overall application quality score was 3.02 ± 0.40 out of 5 ("acceptable"), with 61% (28/46) rated as "poor" (score 2.0-2.9). Applications scored highest for aesthetics (3.24 ± 0.48) and functionality (3.88 ± 0.37) and lowest for information (2.58 ± 0.64) and engagement (2.39 ± 0.65). Disease management applications were of significantly higher quality than education-focused applications (3.59 ± 0.38 vs 2.88 ± 0.26, P < .001). There was no correlation between graded quality and either user ratings or the number of downloads. Conclusion While numerous smartphone applications exist to support patients with GERD, their quality is variable. Patient education applications are of particularly low quality. Our findings can help to inform the selection of applications by patients and guide clinicians' recommendations. This study also highlights the need for higher-quality, evidence-informed applications aimed at GERD patient education.
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Affiliation(s)
- Michelle J. Gould
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chantelle Lin
- SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catharine M. Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the SickKids Research and Learning Institutes, Department of Paediatrics and the Wilson Centre, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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3
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Nusir M, Rekik M. Systematic review of co-design in digital health for COVID-19 research. UNIVERSAL ACCESS IN THE INFORMATION SOCIETY 2022:1-15. [PMID: 36618758 PMCID: PMC9805349 DOI: 10.1007/s10209-022-00964-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Improving the quality of digital health care through information and communication technology can mainly contribute to the clinical, social, financial, and economic systems' success, especially during the COVID-19 pandemic period. The co-design approach, which unleashes the end-user power, can contribute actively in improving the healthcare systems. It deals with understanding the user behaviors, requirements, and motivations through observation, inspection, task analysis, and feedback techniques. Consequently, both the co-design and digital technologies might empower the management of patients' health and that of their families. The research strategy is based on a systematic literature review and meta-analysis to summarize how the co-design methodologies handled the existing technology-based health systems for their improvement. Based on the findings, we establish the following hypotheses: (i) A user-centered methodology for service implementation might offer a promising tool to enhance the healthcare services quality before they be launched; (ii) Several limitations can affect the co-design approach in digital health, such as a bias for a patients' group. Efforts have been made to reduce this risk by identifying bias at an early stage, or different groups should be included in the test phase for example; (iii) Use decision-making devices that handle technologies for patient and clinical healthcare solution.
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Affiliation(s)
- Muneer Nusir
- Department of Information Systems, College of Computer Engineering and Sciences, Prince Sattam bin Abdulaziz University, Alkharj, 16278 Saudi Arabia
| | - Molka Rekik
- Department of Information Systems, College of Computer Engineering and Sciences, Prince Sattam bin Abdulaziz University, Alkharj, 16278 Saudi Arabia
- Data Engineering and Semantics Research Unit, University of Sfax, Sfax, Tunisia
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4
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Messner EM, Sturm N, Terhorst Y, Sander LB, Schultchen D, Portenhauser A, Schmidbaur S, Stach M, Klaus J, Baumeister H, Walter BM. Mobile Apps for the Management of Gastrointestinal Diseases: Systematic Search and Evaluation Within App Stores. J Med Internet Res 2022; 24:e37497. [PMID: 36197717 PMCID: PMC9582913 DOI: 10.2196/37497] [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: 02/23/2022] [Revised: 05/30/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear. Objective This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases. Methods A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality. Results The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05). Conclusions Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps.
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Affiliation(s)
- Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Niklas Sturm
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany.,Department of Research Methods, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Freiburg at Breisgau, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Alexandra Portenhauser
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Simone Schmidbaur
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, University of Ulm, Ulm, Germany
| | - Jochen Klaus
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Benjamin M Walter
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
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5
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Ruyobeza B, Grobbelaar SS, Botha A. Hurdles to developing and scaling remote patients' health management tools and systems: a scoping review. Syst Rev 2022; 11:179. [PMID: 36042505 PMCID: PMC9427160 DOI: 10.1186/s13643-022-02033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite all the excitement and hype generated regarding the expected transformative impact of digital technology on the healthcare industry, traditional healthcare systems around the world have largely remained unchanged and resultant improvements in developed countries are slower than anticipated. One area which was expected to significantly improve the quality of and access to primary healthcare services in particular is remote patient monitoring and management. Based on a combination of rapid advances in body sensors and information and communication technologies (ICT), it was hoped that remote patient management tools and systems (RPMTSs) would significantly reduce the care burden on traditional healthcare systems as well as health-related costs. However, the uptake or adoption of above systems has been extremely slow and their roll out has not yet properly taken off especially in developing countries where they ought to have made the greatest positive impact. AIM The aim of the study was to assess whether or not recent, relevant literature would support the development of in-community, design, deployment and implementation framework based on three factors thought to be important drivers and levers of RPMTS's adoption and scalability. METHODS A rapid, scoping review conducted on relevant articles obtained from PubMed, MEDLINE, PMC and Cochrane databases and grey literature on Google and published between 2012 and May 2020, by combining a number of relevant search terms and phrases. RESULTS Most RPMTSs are targeted at and focused on a single disease, do not extensively involve patients and clinicians in their early planning and design phases, are not designed to best serve a specific catchment area and are mainly directed at post-hospital, disease management settings. This may be leading to a situation where patients, potential patients and clinicians simply do not make use of these tools, leading to low adoption and scalability thereof. CONCLUSION The development of a user-centred, context-dependent, customizable design and deployment framework could potentially increase the adoption and scalability of RPMTSs, if such framework addressed a combination of diseases, prevalent in a given specific catchment area, especially in developing countries with limited financial resources.
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Affiliation(s)
- Barimwotubiri Ruyobeza
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, South Africa
| | - Sara S Grobbelaar
- Department of Industrial Engineering, Stellenbosch University, South Africa AND DSI-NRF Centre of Excellence in Scientometrics and Science, Technology and Innovation Policy (SciSTIP), Stellenbosch University, Stellenbosch, South Africa.
| | - Adele Botha
- Department of Industrial Engineering, Stellenbosch University and CSIR Next Generation Enterprises and Institutions, Stellenbosch, South Africa
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6
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Shaikh A, Khan M, Ismail FW. Experience of Telemedicine in Gastroenterology Out-Patient Practice During the COVID-19 Pandemic: Experiences from a Tertiary-Care Hospital in a Developing Country. Clin Exp Gastroenterol 2022; 15:91-99. [PMID: 35747839 PMCID: PMC9211076 DOI: 10.2147/ceg.s361381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Telemedicine is being widely implemented in the COVID-19 pandemic to avoid infection risk. However, its effectiveness has not been evaluated, especially in developing countries, where it is invaluable for healthcare access. This study assesses physicians’ and patients’ perspectives of the usefulness and challenges of telemedicine in the gastroenterology department to identify its pitfalls. Methods A cross-sectional telephonic survey was conducted on patients presenting to the gastroenterology department at a tertiary care hospital in Pakistan. An online survey was sent to physicians in the department. Results A total of 160 patients participated, with a mean age 49.8 years, and 42.8% (n=68) males. There were 23.8% (n=38) initial visits and 76.3% (n=122) follow-ups. More than 85% of patients agreed telemedicine saved cost and time, 46.5% (n=74) said it improved healthcare access, and 76.3% (n=122) wanted to use it again. More than 80% were satisfied with the physician-patient interaction. Of the 7 physicians who participated, most felt telemedicine was inadequately facilitated, but felt comfortable with technology. Most felt it did not negatively affect healthcare, but thought it was complex for patients and that lack of physical interaction is a limitation. Nearly half were in favor of continuing its use after the pandemic. Conclusion Telemedicine is an effective alternative to in-person visits. Patients find it convenient, with adequate interaction. Physicians have reservations that need addressal, such as poor administration. Most patients and half of physicians are welcome to using telemedicine in the post-COVID era.
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Affiliation(s)
- Anjiya Shaikh
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Maria Khan
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Faisal Waseem Ismail
- Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
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7
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Wilkens R, Dolinger M, Burisch J, Maaser C. Point-of-Care Testing and Home Testing: Pragmatic Considerations for Widespread Incorporation of Stool Tests, Serum Tests, and Intestinal Ultrasound. Gastroenterology 2022; 162:1476-1492. [PMID: 34995530 DOI: 10.1053/j.gastro.2021.10.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/13/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022]
Abstract
Breaking through the biologic therapy efficacy plateau for inflammatory bowel disease requires the strategic development of personalized biomarkers in the tight control model. After risk stratification early in the disease course, targeted serial monitoring consistently to assess clinical outcomes in response to therapy allows for quick therapeutic adjustments before bowel damage can occur. Point-of-care intestinal ultrasound performed by the treating gastroenterologist is an accurate cross- sectional biomarker that monitors intestinal inflammation in real-time, enhances patient care, and increases shared understanding to help achieve common treatment goals. Combining intestinal ultrasound during a clinic visit with existing serum and stool biomarkers in a home testing setup with electronic health monitoring allows for an optimized, patient-centered personalized treatment algorithm that may improve treatment outcomes. Here, we review the current state, pragmatic considerations, and future implications of point-of-care testing and home testing for noninvasive inflammatory bowel disease monitoring in the tight control model.
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Affiliation(s)
- Rune Wilkens
- Gastrounit, Division of Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Copenhagen, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Denmark; Digestive Disease Center, Copenhagen University Hospital - Bispebjerg & Frederiksberg, Copenhagen, Denmark.
| | - Michael Dolinger
- Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johan Burisch
- Gastrounit, Division of Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Copenhagen, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Denmark
| | - Christian Maaser
- Inflammatory Bowel Disease Outpatient Unit, Department of Geriatric Medicine, University Teaching Hospital Lueneburg, Lueneburg, Germany
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8
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Corman BHP, Rajupet S, Ye F, Schoenfeld ER. The Role of Unobtrusive Home-Based Continuous Sensing in the Management of Post-Acute Sequelae of SARS CoV-2. J Med Internet Res 2021; 24:e32713. [PMID: 34932496 PMCID: PMC8989385 DOI: 10.2196/32713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
UNSTRUCTURED Amid the COVID-19 pandemic, it has been reported that greater than 35% of patients with confirmed or suspected COVID-19 develop post-acute sequelae of SARS CoV-2 (PASC). PASC is still a disease for which preliminary medical data is being collected-mostly measurements collected during hospital or clinical visits-and pathophysiological understanding is yet in its infancy. The disease is notable for its prevalence and its variable symptom presentation and as such, management plans could be more holistically made if health care providers had access to unobtrusive home-based wearable and contactless continuous physiologic and physical sensor data. Such between-hospital or between-clinic data can quantitatively elucidate a majority of the temporal evolution of PASC symptoms. While not universally of comparable accuracy to gold-standard medical devices, home-deployed sensors offer great insights into the development and progression of PASC. Suitable sensors include those providing vital signs and activity measurements that correlate directly or by proxy to documented PASC symptoms. Such continuous, home-based data can give care providers contextualized information from which symptom exacerbation or relieving factors may be classified. Such data can also improve the collective academic understanding of PASC by providing temporally and activity-associated symptom cataloging. In this viewpoint, we make a case for the utilization of home-based continuous sensing that can serve as a foundation from which medical professionals and engineers may develop and pursue long-term mitigation strategies for PASC.
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Affiliation(s)
- Benjamin Harris Peterson Corman
- Renaissance School of Medicine, Stony Brook University, Stony Brook, US.,Program in Public Health, Stony Brook University, Stony Brook, US
| | - Sritha Rajupet
- Department of Family, Population & Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, US.,Department of Biomedical Informatics, Renaissance School of Medicine, Stony Brook University, Stony Brook, US
| | - Fan Ye
- Department of Electrical and Computer Engineering, College of Engineering and Applied Science, Stony Brook University, Light Engineering Building, Room 217Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, US
| | - Elinor Randi Schoenfeld
- Department of Family, Population & Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, US
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9
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Lahat A, Shatz Z. Telemedicine in clinical gastroenterology practice: what do patients prefer? Therap Adv Gastroenterol 2021; 14:1756284821989178. [PMID: 33633797 PMCID: PMC7887676 DOI: 10.1177/1756284821989178] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 pandemic has forced major changes on healthcare systems. Maintaining regular patients' surveillance became a major challenge. Telemedicine has been promoted as an economic and effective way for long distance patient care. Our aim was to study patients' acceptance and perspectives on telemedicine. METHODS Patients scheduled for clinic appointments were offered telemedicine. Those who agreed were asked to fill in a questionnaire assessing their satisfaction with the medical consultation. Patients' demographic characteristics and answers were collected and reviewed. RESULTS Out of 358 patients approached 71 agreed to use telemedicine. Of them, 59 completed the questionnaire and were included in the study. All patients' basic demographic data were collected. Patients' included in the study mean age was: 43 ± 16.3 years, 35 (59.3%) women. Patients who chose not to use telemedicine were significantly older, mean age: 61 ± 15.2 years (p = 0.036), 134 (46.7%) women. Most patients included (38; 64.4%) had inflammatory bowel disease (IBD). Most patients who chose not to use telemedicine were non-IBD patients (206, 72%). Fifty-one patients (86.4%) assessed their experience as 'good' or 'excellent'. Satisfied patients had significantly less time under medical follow-up (3.7 versus 6.1 years, p = 0.028) and tended to be younger (p = non-significant). Women were statistically significantly more satisfied than men (33 versus 18, p = 0.05). Advantages reported were 'time saving' (31.3%), accessibility (26.1%), availability (25%). The main disadvantage was absence of physical examination (70%). CONCLUSIONS Telemedicine gained a high satisfaction rate among patients under regular medical surveillance. Most patients stated this that method is convenient, time saving and increases their compliance. Patients who agreed to telecare were younger, and tended to be of female gender and experiencing IBD. Further studies are needed to characterize specific barriers to telecare usage.
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Affiliation(s)
- Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, 52621, Israel
| | - Zina Shatz
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Israel
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10
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Zhen J, Marshall JK, Nguyen GC, Atreja A, Narula N. Impact of Digital Health Monitoring in the Management of Inflammatory Bowel Disease. J Med Syst 2021; 45:23. [PMID: 33449213 PMCID: PMC7808932 DOI: 10.1007/s10916-021-01706-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 01/12/2023]
Abstract
Technological advances now permit self-management strategies using mobile applications which could greatly benefit patient care. The purpose of this study was to investigate whether the use of the inflammatory bowel disease (IBD) digital health monitoring platform, HealthPROMISE, leads to better quality of care and improved health outcomes in IBD patients. IBD patients were recruited in gastroenterology clinics and asked to install the HealthPROMISE application onto their smartphones. Patient satisfaction, quality of care, quality of life, patient symptoms, and resource utilization metrics were collected throughout the study and sent directly to their healthcare teams. Patients with abnormal symptom/SIBDQ scores were flagged for their physicians to follow up. After one-year, patient outcome metrics were compared to baseline values. Overall, out of 59 patients enrolled in the study, 32 patients (54%) logged into the application at least once during the study period. The number of IBD-related ER visits/hospitalizations in the year of use compared to the prior year demonstrated a significant decrease from 25% of patients (8/32) to 3% (1/32) (p = 0.03). Patients also reported an increase in their understanding of the nature/causes of their condition after using the application (p = 0.026). No significant changes were observed in the number of quality indicators met (p = 0.67) or in SIBDQ scores (p = 0.48). Given the significant burden of IBD, there is a need to develop effective management strategies. This study demonstrated that digital health monitoring platforms may aid in reducing the number of ER visits and hospitalizations in IBD patients.
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Affiliation(s)
- Jamie Zhen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John K Marshall
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Geoffrey C Nguyen
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Canada.,Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ashish Atreja
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Neeraj Narula
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
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11
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Östlund I, Werner M, Karling P. Self-monitoring with home based fecal calprotectin is associated with increased medical treatment. A randomized controlled trial on patients with inflammatory bowel disease. Scand J Gastroenterol 2021; 56:38-45. [PMID: 33284639 DOI: 10.1080/00365521.2020.1854342] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Self-monitoring of inflammatory bowel disease (IBD) with the assistant of telemedicine and home-based fecal calprotectin (FC) tests is evolving in the management of IBD. We performed a randomized controlled trial to investigate the compliance and effects of the model IBD-Home in patients with IBD. MATERIALS AND METHODS Patients were randomized to IBD-Home + standard care (n = 84) or standard care alone (n = 74). Intervention with IBD-Home included IBDoc® FC test kits and a digital application used for answering symptom questionnaires (Abbvie/Telia). They were instructed to use these on demand during a 12-month period. Data was collected retrospectively from medical records. Patients who completed the intervention were phoned and asked to answer a survey about the experience of IBD-Home. RESULTS The compliance to IBD-Home was low (29%). Women were more compliant compared with men (43% vs 17%, p < .001). A significantly higher proportion of patients in the IBD-Home group increased their medical treatment during the study period in comparison to control subjects (33% vs 15% p = .007) and there was an association between an increase in treatment and compliance to IBD home (multivariate odds ratio 3.22; 95th confidence interval 1.04 - 9.95). Overall patients reported a positive experience with slight technical difficulties. CONCLUSION Self-monitoring with home based fecal calprotectin and a digital application was found feasible and appreciated by compliers. Compliance to the IBD-Home model was more common in women and associated with an increased treatment for IBD.
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Affiliation(s)
- Isak Östlund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mårten Werner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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12
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Weerts ZZRM, Heinen KGE, Masclee AAM, Quanjel ABA, Winkens B, Vork L, Rinkens PELM, Jonkers DMAE, Keszthelyi D. Smart Data Collection for the Assessment of Treatment Effects in Irritable Bowel Syndrome: Observational Study. JMIR Mhealth Uhealth 2020; 8:e19696. [PMID: 33030150 PMCID: PMC7669448 DOI: 10.2196/19696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/30/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND End-of-day symptom diaries are recommended by drug regulatory authorities to assess treatment response in patients with irritable bowel syndrome. We developed a smartphone app to measure treatment response. OBJECTIVE Because the employment of an app to measure treatment response in irritable bowel syndrome is relatively new, we aimed to explore patients' adherence to diary use and characteristics associated with adherence. METHODS A smartphone app was developed to serve as a symptom diary. Patients with irritable bowel syndrome (based on Rome IV criteria) were instructed to fill out end-of-day diary questionnaires during an 8-week treatment. Additional online questionnaires assessed demographics, irritable bowel syndrome symptom severity, and psychosocial comorbidities. Adherence rate to the diary was defined as the percentage of days completed out of total days. Adherence to the additional web-based questionnaires was also assessed. RESULTS Overall, 189 patients were included (age: mean 34.0 years, SD 13.3 years; female: 147/189, 77.8%; male: 42/189, 22.2%). The mean adherence rate was 87.9% (SD 9.4%). However, adherence to the diary decreased over time (P<.001). No significant association was found between adherence and gender (P=.84), age (P=.22), or education level (lower education level: P=.58, middle education level: P=.46, versus high education level), while higher anxiety scores were associated with lower adherence (P=.03). Adherence to the online questionnaires was also high (>99%). Missing data due to technical issues were limited. CONCLUSIONS The use of a smartphone app as a symptom diary to assess treatment response resulted in high patient adherence. The data-collection framework described led to standardized data collection with excellent completeness and can be used for future randomized controlled trials. Due to the slight decrease in adherence to diary use throughout the study, this method might be less suitable for longer trials.
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Affiliation(s)
- Zsa Zsa R M Weerts
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Koert G E Heinen
- MEMIC Center for Data and Information Management, Maastricht University, Maastricht, Netherlands
| | - Ad A M Masclee
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Amber B A Quanjel
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University Medical Center+, Maastricht, Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Lisa Vork
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Paula E L M Rinkens
- MEMIC Center for Data and Information Management, Maastricht University, Maastricht, Netherlands
| | - Daisy M A E Jonkers
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Daniel Keszthelyi
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
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13
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Towards understanding how individuals with inflammatory bowel disease use contemporary social media platforms for health-related discourse. COMPUTERS IN HUMAN BEHAVIOR 2020. [DOI: 10.1016/j.chb.2020.106463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Khorshid M, Bakheet N, Abdallah S, Essam M, Cordie A. COVID-19: A strong call for remote medicine in inflammatory bowel disease. J Dig Dis 2020; 21:597-599. [PMID: 32888261 DOI: 10.1111/1751-2980.12935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/26/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Nader Bakheet
- Department of Endemic Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mahmoud Essam
- Department of Endemic Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Cordie
- Department of Endemic Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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15
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Dowd AJ, Warbeck CB, Tang KT, Fung T, Culos-Reed SN. MyHealthyGut: Findings from a pilot randomized controlled trial on adherence to a gluten-free diet and quality of life among adults with celiac disease or gluten intolerance. Digit Health 2020; 6:2055207620903627. [PMID: 32071731 PMCID: PMC6997956 DOI: 10.1177/2055207620903627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/26/2019] [Indexed: 01/11/2023] Open
Abstract
Aims The purpose of this study was to assess the effectiveness of a smartphone app
(MyHealthyGut) in helping adults self-manage celiac disease or gluten
intolerance and improve their gut health. Methods Adults diagnosed with celiac disease or gluten intolerance
(N = 115) were randomized into two groups: experimental
group 1 (had access to the app for a one-month period) or wait list control
(WLC). After one month, WLC participants were given one-month access to the
app (experimental group 2). An online questionnaire was administered to
assess (a) user satisfaction with the app and (b) changes in the following
patient-reported outcomes: adherence to a gluten-free diet, quality of life
(QoL), self-regulatory efficacy, and feelings of depression and anxiety.
Generalized estimating equations were used to assess changes in the outcome
variables over time between the groups. Results Participants reported high levels of app usability, were satisfied with
features of the app, and felt that the app was best suited for people newly
diagnosed with celiac disease. Participants in the experimental groups
reported improvements in adherence, gastrointestinal symptoms (experimental
group 1 only), QoL, self-regulatory efficacy (experimental group 2 only),
anxiety (experimental group 1 only), and depression (experimental group 2
only). Experimental group 1 and the WLC group reported significantly worse
adherence after using the app based on the Celiac Dietary Adherence Test,
which was in contrast to the accidental and purposeful measures of gluten
consumption and symptoms for experimental group 1 but consistent with
reports of accidental and purposeful gluten consumption and symptoms for the
WLC group. Conclusions Based on feedback from the participants, the app may be best suited for
individuals newly diagnosed or struggling with celiac disease or gluten
intolerance. After using the MyHealthyGut app for a one-month period, adults
with celiac disease reported improvements in psychosocial outcomes. Further
iterations of the app are needed to meet the needs of this population
better. MyHealthyGut is the first evidence-based app designed to help people
with celiac disease or gluten intolerance.
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Affiliation(s)
| | | | | | - Tak Fung
- Research Computing Services, Information Technologies, University of Calgary, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Canada
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16
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FODMAP-specific mobile application: impact on gut symptoms in 11,689 people, and dietary triggers in 2,053 people. Proc Nutr Soc 2020. [DOI: 10.1017/s0029665119001290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Abstract
Emergence of health-related smartphone applications and their wide dissemination in public as well as healthcare practitioners has undergone criticism under the scope of public health. Still, despite methodological issues curbing the initial enthusiasm, availability, safety and, in certain cases, documented efficacy of these measures has secured regulatory approval. Bearing in mind these pitfalls, we describe the necessary steps towards implementation of deep learning techniques in the specific clinical context of women’s health and infertility in particular.
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18
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Dorn SD. Gastroenterologists Without Borders: Using Virtual Care to Reach Beyond the Clinic Walls. Gastroenterology 2019; 157:272-274. [PMID: 30981788 DOI: 10.1053/j.gastro.2019.03.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Spencer D Dorn
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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19
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Muthusamy VR, Komanduri S. Innovating in Your Practice: Overcoming Barriers to Create New Opportunities. Clin Gastroenterol Hepatol 2019; 17:580-583. [PMID: 30218701 DOI: 10.1016/j.cgh.2018.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California.
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20
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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: 16] [Impact Index Per Article: 2.7] [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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21
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Ludvigsson JF, Ciacci C, Green PH, Kaukinen K, Korponay-Szabo IR, Kurppa K, Murray JA, Lundin KEA, Maki MJ, Popp A, Reilly NR, Rodriguez-Herrera A, Sanders DS, Schuppan D, Sleet S, Taavela J, Voorhees K, Walker MM, Leffler DA. Outcome measures in coeliac disease trials: the Tampere recommendations. Gut 2018; 67:1410-1424. [PMID: 29440464 PMCID: PMC6204961 DOI: 10.1136/gutjnl-2017-314853] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/19/2017] [Accepted: 01/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A gluten-free diet is the only treatment option of coeliac disease, but recently an increasing number of trials have begun to explore alternative treatment strategies. We aimed to review the literature on coeliac disease therapeutic trials and issue recommendations for outcome measures. DESIGN Based on a literature review of 10 062 references, we (17 researchers and 2 patient representatives from 10 countries) reviewed the use and suitability of both clinical and non-clinical outcome measures. We then made expert-based recommendations for use of these outcomes in coeliac disease trials and identified areas where research is needed. RESULTS We comment on the use of histology, serology, clinical outcome assessment (including patient-reported outcomes), quality of life and immunological tools including gluten immunogenic peptides for trials in coeliac disease. CONCLUSION Careful evaluation and reporting of outcome measures will increase transparency and comparability of coeliac disease therapeutic trials, and will benefit patients, healthcare and the pharmaceutical industry.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Carolina Ciacci
- Coeliac Center at Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Peter Hr Green
- Celiac Disease Center at Columbia University, New York, USA
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilma R Korponay-Szabo
- Coeliac Disease Centre, Heim Pál Children's Hospital, Budapest, Hungary
- Department of Paediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kalle Kurppa
- Celiac Disease Research Center, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | | | - Knut Erik Aslaksen Lundin
- Institute of Clinical Medicine and K.G. Jebsen Coeliac Disease Research Centre, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Markku J Maki
- Science Center, Tampere University Hospital, Tampere, Finland
- Tampere Centre for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Alina Popp
- Institute for Mother and Child Health Bucharest, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
- Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland
| | - Norelle R Reilly
- Division of Pediatric Gastroenterology, Columbia University Medical Center, New York, USA
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, USA
| | | | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Detlef Schuppan
- Celiac Center, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Juha Taavela
- Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland
| | | | - Marjorie M Walker
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Daniel A Leffler
- Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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22
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Kelso M, Feagins LA. Can Smartphones Help Deliver Smarter Care for Patients With Inflammatory Bowel Disease? Inflamm Bowel Dis 2018; 24:1453-1459. [PMID: 29868764 DOI: 10.1093/ibd/izy162] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 12/16/2022]
Abstract
The addition of smartphone applications to the armamentarium of tools to help manage patients with inflammatory bowel disease (IBD) has the potential to improve care in multiple ways, including enhanced disease understanding, improved adherence to medications, accessible support networks, and earlier interventions by medical professionals when problems arise. However, at present, for patients with IBD, the development of such mobile applications is still in its infancy. We conducted a review of the literature and online resources including phone application stores (Apple and Android app stores) to assess the current availability of mobile health applications for IBD patients and opportunities to increase patient engagement. We also addressed the limitations and challenges of patient and provider adoption of mobile-based technologies for IBD self-management and remote monitoring.
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Affiliation(s)
- Michael Kelso
- Department of Medicine, VA North Texas Healthcare System, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Linda A Feagins
- Department of Medicine, VA North Texas Healthcare System, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
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23
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Abstract
PURPOSE OF REVIEW Mobile apps are now increasingly used in conjunction with telemedicine and wearable devices to support remote patient monitoring (RPM). The goal of this paper is to review the available evidence and assess the scope of RPM integration into standard practices for care and management of chronic disease in general and, more specifically, inflammatory bowel disease (IBD). RECENT FINDINGS RPM has been associated with improvements in health outcomes and indicators across a broad range of chronic diseases. However, there is limited data on the effectiveness of RPM in IBD care. From the emerging literature and body of research, we found promising results about the feasibility of integrating RPM in IBD care and RPM's capacity to support IBD improvement in key process and outcome metrics. Concerns regarding privacy and provider acceptability have limited the mass integration of RPM to date. However, with the healthcare industry's move toward value-based population care and the advent of novel payment models for RPM reimbursement, the adoption of RPM into standard IBD care practices will likely increase as the technology continues to improve and become a mainstream tool for healthcare delivery in the near future.
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24
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Comerford M, Fogel R, Bailey JR, Chilukuri P, Chalasani N, Lammert CS. Leveraging Social Networking Sites for an Autoimmune Hepatitis Genetic Repository: Pilot Study to Evaluate Feasibility. J Med Internet Res 2018; 20:e14. [PMID: 29348111 PMCID: PMC5795096 DOI: 10.2196/jmir.7683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/25/2017] [Accepted: 06/30/2017] [Indexed: 12/26/2022] Open
Abstract
Background Conventional approaches to participant recruitment are often inadequate in rare disease investigation. Social networking sites such as Facebook may provide a vehicle to circumvent common research limitations and pitfalls. We report our preliminary experience with Facebook-based methodology for participant recruitment and participation into an ongoing study of autoimmune hepatitis (AIH). Objective The goal of our research was to conduct a pilot study to assess whether a Facebook-based methodology is capable of recruiting geographically widespread participants into AIH patient-oriented research and obtaining quality phenotypic data. Methods We established a Facebook community, the Autoimmune Hepatitis Research Network (AHRN), in 2014 to provide a secure and reputable distillation of current literature and AIH research opportunities. Quarterly advertisements for our ongoing observational AIH study were posted on the AHRN over 2 years. Interested and self-reported AIH participants were subsequently enrolled after review of study materials and completion of an informed consent by our study coordinator. Participants returned completed study materials, including epidemiologic questionnaires and genetic material, to our facility via mail. Outside medical records were obtained and reviewed by a study physician. Results We successfully obtained all study materials from 29 participants with self-reported AIH within 2 years from 20 different states. Liver biopsy results were available for 90% (26/29) of participants, of which 81% (21/29) had findings consistent with AIH, 15% (4/29) were suggestive of AIH with features of primary biliary cholangitis (PBC), and 4% (1/29) had PBC alone. A total of 83% (24/29) had at least 2 of 3 proposed criteria: positive autoimmune markers, consistent histologic findings of AIH on liver biopsy, and reported treatment with immunosuppressant medications. Self-reported and physician records were discrepant for immunosuppressant medications or for AIH/PBC diagnoses in 4 patients. Conclusions Facebook can be an effective ancillary tool for facilitating patient-oriented research in rare diseases. A social media-based approach transcends established limitations in rare disease research and can further develop research communities.
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Affiliation(s)
- Megan Comerford
- Division of Digestive and Liver Diseases, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Rachel Fogel
- Division of Digestive and Liver Diseases, Indiana University School of Medicine, Indianapolis, IN, United States
| | - James Robert Bailey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Prianka Chilukuri
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Naga Chalasani
- Division of Digestive and Liver Diseases, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig Steven Lammert
- Division of Digestive and Liver Diseases, Indiana University School of Medicine, Indianapolis, IN, United States
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25
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Bossuyt P, Pouillon L, Bonnaud G, Danese S, Peyrin-Biroulet L. E-health in inflammatory bowel diseases: More challenges than opportunities? Dig Liver Dis 2017; 49:1320-1326. [PMID: 28899622 DOI: 10.1016/j.dld.2017.08.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 02/09/2023]
Abstract
Patients with inflammatory bowel disease need close monitoring for an optimal disease management. For this, e-health technologies are promising tools. But the current evidence for the implementation of e-health in inflammatory bowel disease is weak. For this a critical evaluation of the existing evidence is presented. Furthermore some essential conditions need to be full-filled. We need a robust digital infrastructure that is workable for the patient and the healthcare provider. Important legal issues need to be solved to protect the patient. And the e-health technologies will have to proof their durability, feasibility and acceptance for the patient on the long term.
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Affiliation(s)
- Peter Bossuyt
- Imelda GI clinical research centre, Imelda General Hospital Bonheiden, Bonheiden, Belgium.
| | - Lieven Pouillon
- Department of Hepato-Gastroenterology, University Hospitals Gasthuisberg Leuven, Leuven, Belgium
| | - Guillaume Bonnaud
- Department of Hepato-Gastroenterology, Ambroise Paré Clinic, Toulouse, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
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26
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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: 66] [Impact Index Per Article: 9.4] [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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27
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Ansaa Osae-Larbi J. Digital Technology Healthcare Solutions in an Era of Moving Populations and Chronic Illnesses: Are We Being Realistically Smart? EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10310363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In 2015, the world recorded its highest numbers of international migrants and forced displacement since World War II. With this historic rise in migrants, refugees, and displaced persons around the world, there is a huge risk of chronic illness burden on healthcare systems. Thus, healthcare systems may need to incorporate innovative digital healthcare solutions into their processes and procedures. The purpose of this article is to present the argument that for effective prevention and management of chronic illnesses in ever-increasing migrant societies to be achieved, mobile digital healthcare technologies must be realistically smart and strategically adopted. Beginning with an overview of the current global migration trend, this article considers the implications of this trend for chronic illnesses and the potential for mobile health technologies to support achievement of healthcare outcomes. It highlights three core reasons why digital innovations may be limited as tools for helping to address the global chronic illness challenge and identifies important directions for mobile health technology developers, healthcare professionals, researchers, government and funding agencies, and public health ministries, with a focus on the strategic development and adoption of ‘realistically smart’ phones. The article concludes with recommendations for research and public health education.
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Affiliation(s)
- Judith Ansaa Osae-Larbi
- Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, Legon, Ghana
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28
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Kulanthaivel A, Fogel R, Jones J, Lammert C. Digital Cohorts Within the Social Mediome: An Approach to Circumvent Conventional Research Challenges? Clin Gastroenterol Hepatol 2017; 15:614-618. [PMID: 28433255 PMCID: PMC5407392 DOI: 10.1016/j.cgh.2017.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Anand Kulanthaivel
- Indiana University- Purdue University Indianapolis, School of Informatics and Computing
| | - Rachel Fogel
- Indiana University School of Medicine, Department of Digestive and Liver Diseases
| | - Josette Jones
- Indiana University- Purdue University Indianapolis, School of Informatics and Computing
| | - Craig Lammert
- Department of Digestive and Liver Diseases, Indiana University School of Medicine, Indianapolis, Indiana.
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29
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Buchman AS, Boyle PA, Bennett DA. Expanding the Toolkit for Studies of Aging. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2017; 4:69-70. [PMID: 29177136 DOI: 10.14283/jpad.2017.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612
| | - P A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612
| | - D A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612
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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: 7.0] [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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Click B, Anderson AM, Binion DG. Predicting Costs of Care for Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2017; 15:393-395. [PMID: 27923719 PMCID: PMC5316305 DOI: 10.1016/j.cgh.2016.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Benjamin Click
- Division of Gastroenterology, Hepatology, and Nutrition, University of
Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alyce M. Anderson
- Division of Gastroenterology, Hepatology, and Nutrition, University of
Pittsburgh Medical Center, Pittsburgh, Pennsylvania,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David G. Binion
- Division of Gastroenterology, Hepatology, and Nutrition, University of
Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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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: 4.6] [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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Kosinski L, Brill JV. The Promise of Patient Self-Monitoring: An App a Day Won't Necessarily Keep the Doctor Away. Clin Gastroenterol Hepatol 2016; 14:1751-1752. [PMID: 27544627 DOI: 10.1016/j.cgh.2016.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 02/07/2023]
Affiliation(s)
| | - Joel V Brill
- Predictive Health, LLC, Paradise Valley, Arizona
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