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Hermsen S, Tump D, Wentink E, Duijvestein M. Investigating Patient Perspectives on Using eHealth Technologies for the Self-Management of Inflammatory Bowel Disease: Mixed Methods Study. J Med Internet Res 2024; 26:e53512. [PMID: 39240663 DOI: 10.2196/53512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) poses significant challenges for patients, requiring continuous monitoring and self-management to improve quality of life. OBJECTIVE This study aims to investigate the viewpoints of individuals living with IBD on the use of information and communication technology (ICT) for the self-management of their condition, with a particular focus on the concept of a "smart" toilet seat as an example of ICT for IBD self-management. METHODS We conducted an analysis of questionnaire responses obtained from 724 participants. They were encouraged to share their use cases and identify any perceived barriers associated with ICT adoption for managing their condition. To assess their responses, we used descriptive quantitative analysis, summative content analysis, and thematic qualitative analysis. We combined these results in an epistemic network analysis to look for meaningful patterns in the responses. RESULTS Of the 724 participants, more than half (n=405, 55.9%) were already using various forms of ICT for IBD self-management. The primary factor influencing their use of ICT was their affinity for interacting with technology. Distinct differences emerged between individuals who were using ICT and those who were not, particularly regarding their perceived use cases and concerns. CONCLUSIONS This study provides valuable insights into the perspectives of individuals with IBD on the use of ICT for self-management. To facilitate wider adoption, addressing privacy concerns, ensuring data security, and establishing reliable ICT integration will be critical.
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Affiliation(s)
- Sander Hermsen
- OnePlanet Research Centre, Precision Health and Nutrition Group, Wageningen, Netherlands
- Radboud University Medical Centre, Prevention Hub, Nijmegen, Netherlands
| | - Danielle Tump
- OnePlanet Research Centre, Precision Health and Nutrition Group, Wageningen, Netherlands
| | - Eva Wentink
- OnePlanet Research Centre, Precision Health and Nutrition Group, Wageningen, Netherlands
| | - Marjolijn Duijvestein
- Radboud University Medical Centre, Department of Gastroenterology, Nijmegen, Netherlands
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Ferret G, Cremades M, Cornejo L, Guillem-López F, Farrés R, Parés D, Julian JF. Economic impact of outpatient follow-up using telemedicine vs in-person visits for patients in general surgery: A secondary analysis of a randomized clinical trial. Cir Esp 2024; 102:314-321. [PMID: 38604567 DOI: 10.1016/j.cireng.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/26/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Innovation in internet connectivity and the Covid 19 pandemic have caused a dramatic change in the management of patients in the medical field, boosting the use of telemedicine. A comparison of clinical outcomes and satisfaction between conventional face-to-face and telemedicine follow-up in general surgery, an economic evaluation is mandatory. The aim of the present study was to compare the differences in economic costs between these two outpatient approaches in a designed randomized controlled trial (RCT). METHODS A RCT was conducted enrolling 200 patients to compare conventional in-person vs. digital health follow-up using telemedicine in the outpatient clinics in patients of General Surgery Department after their planned discharge. After a demonstration that no differences were found in clinical outcomes and patient satisfaction, we analyzed the medical costs, including staff wages, initial investment, patent's transportation and impact on social costs. RESULTS After an initial investment of 7527.53€, the costs for the Medical institution of in-person conventional follow-up were higher (8180.4€) than those using telemedicine (4630.06€). In relation to social costs, loss of productivity was also increased in the conventional follow-up. CONCLUSION The use of digital Health telemedicine is a cost-effective approach compared to conventional face-to-face follow-up in patients of General Surgery after hospital discharge.
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Affiliation(s)
- Georgina Ferret
- Department of General Surgery, Hospital Universitari Doctor Josep Trueta, Avda. França s/n, 17007 Girona, Spain
| | - Manel Cremades
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol-IGTP, Carretera de Canyet s/n, 08916 Barcelona, Spain
| | - Lídia Cornejo
- Department of General Surgery, Hospital Universitari Doctor Josep Trueta, Avda. França s/n, 17007 Girona, Spain
| | - Francesc Guillem-López
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol-IGTP, Carretera de Canyet s/n, 08916 Barcelona, Spain
| | - Ramon Farrés
- Department of General Surgery, Hospital Universitari Doctor Josep Trueta, Avda. França s/n, 17007 Girona, Spain
| | - David Parés
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol-IGTP, Carretera de Canyet s/n, 08916 Barcelona, Spain.
| | - Joan-Francesc Julian
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol-IGTP, Carretera de Canyet s/n, 08916 Barcelona, Spain
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Gu Z, Gu J, Liu P. The effectiveness of continuity of care in patients with inflammatory bowel disease: a systematic review. BMC Gastroenterol 2024; 24:24. [PMID: 38191358 PMCID: PMC10773097 DOI: 10.1186/s12876-023-03109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024] Open
Abstract
AIM To investigate the effectiveness of continuity of care in patients with inflammatory bowel disease. BACKGROUND The prevalence of inflammatory bowel disease(IBD) is increasing by years, especially in China. Moreover, IBD is prolonged and difficult to heal, which seriously impairs the quality of life of patients. Some studies have identified that continuity of care could contribute to the improvement of the quality of life, but the results remains inconclusive in patients with IBD. METHODS PRISMA guidelines was the outline of this study. Review Manager Software (version 5.3) was used to carry out the data analysis. Outcome assessments included quality of life (QoL), remission rates, number of outpatient clinic visits, and medication adherence. RESULTS Ultimately, 12 studies involving 2415 patients were brought into this meta-analysis. The results indicated there was no significant difference for continuity of care to improve the QoL in intervention group (SMD = 0.02, 95% CI: -0.08, 0.12). Besides, the remission rates of disease had no difference with those patients in the two groups (OR = 1.07, 95% CI: 0.72, 1.60). However, continued care could contribute to the number of outpatient clinic visits (MD = -0.84, 95% CI: -1.19, -0.49) and patients' adherence to medication significantly (OR = 2.40, 95% CI: 1.16, 4.95). CONCLUSIONS IBD patients could benefited from continuity of care with reducing their number of clinic visits and improving medication adherence. Nonetheless, there was no evidence of continuity of care contribute to QoL and remission of disease for these patients.
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Affiliation(s)
- Zijun Gu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, P. R. China
| | - Junyi Gu
- Health School attached to Shanghai University of Medicine & Health Sciences, Shanghai, P. R. China
| | - Ping Liu
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, P. R. China.
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Yu J, Wang Y, Wang H, Li S, Zhou M, Xu J, Lin Z. Association between eHealth literacy, diabetic behavior rating, and burden among caregivers of children with type 1 diabetes: Cross-sectional survey study. J Pediatr Nurs 2023; 73:1-6. [PMID: 37597400 DOI: 10.1016/j.pedn.2023.08.012] [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: 06/04/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The purpose of this study was to clarify the relationship between eHealth literacy, diabetic behavior rating, and caregiving burden among caregivers of children with type 1 diabetes mellitus (T1DM). METHODS A questionnaire-based cross-sectional study of 143 primary caregivers of T1DM was conducted. Electronic health literacy was quantified using the Chinese version of the eHealth Literacy Scale (eHEALS). Their diabetic management behavior rating and caregiving burden were measured by Diabetes Behavior Rating Scale-Parent Version (DBRS-P) and Zarit Burden Interview (ZBI), respectively. Pearson correlation analysis was used to estimate the relationship between the above variables. RESULTS Only 54 (37.76%) caregivers qualified by eHEALS scale, with a total score of 30.07 ± 4.54 out of 40. A positive correlation between DRBS-P scores and the scores of eHEALS (Pearson correlation coefficient r = 0.226, P = 0.007) and a negative correlation between ZBI and eHEALS scores (r = -0.166, P = 0.047) were observed. CONCLUSIONS The eHealth literacy level of caregivers of children with T1DM in China remains to be improved. Caregivers with higher eHealth literacy had better diabetic management behaviors and less caregiving burden. IMPLICATIONS TO PRACTICE This study suggests that hierarchical electronic health-based interventions should be designed according to the different levels of eHealth literacy of individuals, to enhance the ability of caregivers with different eHealth literacy levels to fully utilize eHealth resources to improve their daily disease management skills and reduce their burden when caring for T1DM children. In addition, improving eHealth literacy of caregivers for children with T1DM can be one of the important ways to enhance the effectiveness of electronic health-based programs designed for them.
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Affiliation(s)
- Jian Yu
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Jiangsu, China
| | - Yubing Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Jiangsu, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Jiangsu, China
| | - Sha Li
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Meijing Zhou
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Jiangsu, China
| | - Jingjing Xu
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Jiangsu, China
| | - Zheng Lin
- School of Nursing, Nanjing Medical University, Jiangsu, China; Department of Nursing, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Jiangsu, China.
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Garg A, Sohal A, Kalra S, Singh C, Singh I, Grewal J, Kansal R, Malhotra K, Mahajan R, Midha V, Singh A, Sood A, Bawa A. Inflammatory Bowel Disease and X (Formerly Twitter) Influencers: Who Are They and What Do They Say? Cureus 2023; 15:e47536. [PMID: 38022053 PMCID: PMC10664972 DOI: 10.7759/cureus.47536] [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] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective More than half of the population suffering from inflammatory bowel disease (IBD) use the internet as a primary source of information on their condition. X (formerly Twitter) has been increasingly used to disseminate healthcare-related information. In this study, we aimed to identify top influencers on the topic of IBD on X and correlate the relevance of their social media engagements with their professional expertise or academic productivity. Methods X (formerly Twitter) influence scores for the search topic IBD were obtained using Cronycle API, a proprietary software employing multiple algorithms to rank influencers. Data regarding gender, profession, location, and research productivity represented as h-index was collected. Results We collected information on the top 100 IBD influencers on X. The majority of influencers were gastroenterologists, followed by IBD advocates. Of note, 62% of the IBD influencers were from the US followed by the UK and Canada. A positive correlation was observed between the X topic score and the h-index of the influencer (r=+0.488, p<0.001) Conclusions The strong correlation observed between the X topic score and h-index suggests that social media is a viable platform for gaining information regarding IBD. Further research aimed at counteracting misleading information by providing facts and data in a succinct manner about IBD on social media is required to improve disease awareness.
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Affiliation(s)
- Ayushi Garg
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | | | - Shivam Kalra
- Internal Medicine, Trident Medical Center, North Charleston, USA
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Carol Singh
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ishandeep Singh
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Jasneet Grewal
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Rohin Kansal
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Kashish Malhotra
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ramit Mahajan
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Vandana Midha
- Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Arshdeep Singh
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ajit Sood
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ashvind Bawa
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
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Versteegden DPA, Van Himbeeck MJJ, Luyer MD, van Montfort G, de Zoete JPJGM, Smulders JF, Nienhuijs SW. A randomized clinical trial evaluating eHealth in bariatric surgery. Surg Endosc 2023; 37:7625-7633. [PMID: 37474829 DOI: 10.1007/s00464-023-10211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Supporting patients before, and long after, their bariatric treatment contributes a lot to successful outcome. eHealth interventions have a hypothetical benefit in addition to standard care. This could lead to increased weight loss, reduction of obesity-related diseases, patient adherence, and quality of life. This randomized controlled trial aims to evaluate the value of an eHealth platform and self-monitoring devices as additions to standard bariatric care. MATERIALS AND METHODS Two-hundred-and-five patients who underwent primary bariatric surgery were randomized (2:1:1) to receive standard care (control group), additional access to an educational patient eHealth platform (online group), or additional access to eHealth platform as well as self-monitoring devices (device group). The platform consisted of an interactive educational environment with informational videos, dietary advice, news, and more. The self-monitoring devices used were a weight scale, blood pressure monitor, pulse oximeter, and activity bracelet. The primary endpoint was weight loss and secondary outcomes included reduction of obesity-related diseases, quality of life, and eHealth use. RESULTS Postoperative weight loss, reduction of obesity-related diseases, frequency of consultations, and quality of life were similar between groups. Participation to the eHealth platform was high (online group 90%, device group 98%). Most frequently accessed contents were informational messages, videos, and the treatment preparation modules. The percentage of active users of the self-monitoring devices dropped from 62% in the first postoperative month to 19% after 2 years. Thirteen patients in the device group withdrew due to unwillingness to use self-monitoring devices. CONCLUSION Participation to the eHealth intervention in addition to the standard post-bariatric guidance program was high, however, had no significant impact on clinical outcomes such as weight loss, reduction of obesity-related diseases, and quality of life. Trial registration ClinicalTrials.gov (identifier number NL56992.100.16) https://clinicaltrials.gov/ct2/show/NCT03394638.
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Affiliation(s)
- Dirk P A Versteegden
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Magaly J J Van Himbeeck
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Gust van Montfort
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Jean-Paul J G M de Zoete
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Norouzkhani N, Bahari A, Shirvani JS, Faramarzi M, Eslami S, Tabesh H. Expert opinions on informational and supportive needs and sources of obtaining information in patients with inflammatory bowel disease: a Delphi consensus study. Front Psychol 2023; 14:1224279. [PMID: 37809295 PMCID: PMC10557489 DOI: 10.3389/fpsyg.2023.1224279] [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: 05/17/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background The present study introduces informational and supportive needs and sources of obtaining information in patients with inflammatory bowel disease (IBD) through a three-round Expert Delphi Consensus Opinions method. Methods According to our previous scoping review, important items in the area of informational and supportive needs and sources of obtaining information were elucidated. After omitting duplicates, 56 items in informational needs, 36 items in supportive needs, and 36 items in sources of obtaining information were retrieved. Both open- and close-ended questions were designed for each category in the form of three questionnaires. The questionnaires were sent to selected experts from different specialties. Experts responded to the questions in the first round. Based on the feedback, questions were modified and sent back to the experts in the second round. This procedure was repeated up to the third round. Results In the first round, five items from informational needs, one item from supportive needs, and seven items from sources of obtaining information were identified as unimportant and omitted. Moreover, two extra items were proposed by the experts, which were added to the informational needs category. In the second round, seven, three, and seven items from informational needs, supportive needs, and sources of obtaining information were omitted due to the items being unimportant. In the third round, all the included items gained scores equal to or greater than the average and were identified as important. Kendall coordination coefficient W was calculated to be 0.344 for information needs, 0.330 for supportive needs, and 0.325 for sources of obtaining information, indicating a fair level of agreement between experts. Conclusions Out of 128 items in the first round, the omission of 30 items and the addition of two items generated a 100-item questionnaire for three sections of informational needs, supportive needs, and sources of obtaining information with a high level of convergence between experts' viewpoints.
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Affiliation(s)
- Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Bahari
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahbobeh Faramarzi
- Department of General Courses, Population, Family and Spiritual Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Graff LA, Geist R, Kuenzig ME, Benchimol EI, Kaplan GG, Windsor JW, Bitton A, Coward S, Jones JL, Lee K, Murthy SK, Peña-Sánchez JN, Targownik LE, Jannati N, Jones May T, Akhtar Sheekha T, Davis T, Weinstein J, Dahlwi G, Im JHB, Amankwah Osei J, Rohatinsky N, Ghandeharian S, Goddard Q, Gorospe J, Gertsman S, Louis M, Wagner R, Brass C, Sanderson R, Bernstein CN. The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2023; 6:S64-S75. [PMID: 37674499 PMCID: PMC10478810 DOI: 10.1093/jcag/gwad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn's disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.
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Affiliation(s)
- Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tyrel Jones May
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tasbeen Akhtar Sheekha
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ghaida Dahlwi
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shira Gertsman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Richelle Wagner
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Zhou W, Wang J, Chen Q, Huang Z, Zhou N, Hu M. Assessment of the operation status of electronic prescription at community pharmacies in Chengdu, China: a simulated patient study. BMC Health Serv Res 2023; 23:920. [PMID: 37644463 PMCID: PMC10466720 DOI: 10.1186/s12913-023-09742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 06/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Information and technologies relevant to eHealth have developed rapidly over the past two decades. Based on this, China piloted "Internet + " pattern and some regions piloted electronic prescription services to explore telepharmacy services. OBJECTIVE To describe the processes and assess the operation status of electronic prescription services mode for community pharmacies in China. METHODS The simulated patient methodology was used to conduct a cross-sectional study in 317 community pharmacies from six districts in Chengdu, China in 2019. Simulated patients expressed three levels of service demands based on scenario about acute upper respiratory tract infections to evaluate the recommendation strength of electronic prescription services and telepharmacy service in community pharmacies. The descriptive statistics was completed to obtain the characteristics of the visit process, student t-test and χ2 test (P < 0.05 was considered statistically significant) were used for inferential statistical analysis to determine differences in characteristics and degree of recommendation between pharmacies. RESULTS Three Hundred Seventeen record sheets were effectively collected. The third-party platform was recommended in 195 (61.5%) interactions. The main reason for not recommending is non-prescription dispensing of prescription drugs (27.1%). 90.3% interactions waited less than 1 min, the counseling duration was less than 5 min in all interactions, and most community pharmacies had good network conditions (81.5%). 97.4% remote physicians offered professional counseling, only 22.1% of the pharmacists provided medication advice. CONCLUSIONS The electronic prescription services mode for community pharmacies in Chengdu provides a convenient drug purchase process but remains some problems. For example, prescribing drugs without a prescription and services provided by pharmacists was poor, etc. The relevant supporting policies should be improved in future development process.
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Affiliation(s)
- Wenxin Zhou
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
| | - Jing Wang
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
- Clinical Research Institute, the Affiliated Hospital of Southwest Medical University, 646000, Luzhou, P.R. China
| | - Qinmin Chen
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
| | - Zhen Huang
- Market Supervision Administration of Chengdu Municipality, 610041, Chengdu, P.R. China
| | - Naitong Zhou
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China.
| | - Ming Hu
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China.
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10
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Karimi N, Moore AR, Lukin A, Connor SJ. Health Communication Research Informs Inflammatory Bowel Disease Practice and Research: A Narrative Review. CROHN'S & COLITIS 360 2023; 5:otad021. [PMID: 37162798 PMCID: PMC10164291 DOI: 10.1093/crocol/otad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 05/11/2023] Open
Abstract
Background In the absence of targeted empirical evidence on effective clinical communication in inflammatory bowel disease (IBD), a broad overview of existing evidence on effective communication in healthcare and available recommendations for communication in telehealth is provided and mapped onto IBD research and practice. Methods A narrative literature review was conducted using Pubmed and Scopus databases and snowballing literature search. Results Evidence-based relationship building strategies include communicating emotions, acknowledging and addressing patients' hesitancy, and ensuring continued support. A particular recommendation regarding telehealth interaction is to avoid long stretches of talk. Effective informational strategies include facilitating and supporting information exchange and considering patients' preferences in decision-making. In teleconsultations, clinicians should ask direct questions about patients' emotional state, clarify their understanding of patients' concerns and check patients' understanding, address at least one patient-reported outcome when discussing the recommended treatment, and shorten the consultation where possible. Strategies for maximizing effective clinical communication in the spoken communicative mode include using infographics and simple language, and assessing adherence at the beginning of the consultation. For teleconsultations, clinicians are advised to allow patients to explain the reason for their call at the beginning of the teleconsultation, probe additional concerns early and before ending the teleconsultation, and be mindful of technical issues such as voice delays. Conclusions Use of question prompt lists, decision aids, micro-lessons, and communication training interventions for clinicians could be beneficial in IBD care. Further research into the implementation of such interventions as well as clinical communication concerns specific to IBD is warranted.
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Affiliation(s)
- Neda Karimi
- Address correspondence to: Neda Karimi, PhD, 1 Campbell Street, Liverpool, NSW 2170, Australia ()
| | | | - Annabelle Lukin
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Susan J Connor
- South Western Sydney Inflammatory Bowel Disease Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
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11
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Jogendran R, O'Connor K, Jeyakumar A, Tandon P, Nguyen GC, Maxwell C, Huang V. Optimizing maternal and neonatal outcomes through tight control management of inflammatory bowel disease during pregnancy: a pilot feasibility study. Sci Rep 2023; 13:8291. [PMID: 37217778 DOI: 10.1038/s41598-023-35332-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
A home point-of care FCP test (IBDoc) and a self-reported clinical disease activity program (IBD Dashboard) may improve routine monitoring of IBD activity during pregnancy. We aimed to evaluate the feasibility of tight control management using remote monitoring in pregnant patients with IBD. Pregnant patients (< 20 weeks) with IBD were prospectively enrolled from Mount Sinai Hospital between 2019 and 2020. Patients completed the IBDoc and IBD Dashboard at three core time points. Disease activity was measured clinically using the Harvey-Bradshaw Index (mHBI) for CD and partial Mayo (pMayo) for UC, or objectively using FCP. A feasibility questionnaire was completed in the third trimester. Seventy-seven percent of patients (24 of 31) completed the IBDoc and IBD Dashboard at all core time points. Twenty-four patients completed the feasibility questionnaires. All survey respondents strongly preferred using the IBDoc over standard lab-based testing and would use the home kit in the future. Exploratory analysis identified discordance rates of more than 50% between clinical and objective disease activity. Tight control management using remote monitoring may be feasible among pregnant patients with IBD. A combination of both clinical scores and objective disease markers may better predict disease activity.
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Affiliation(s)
- Rohit Jogendran
- Division of Gastroenterology and Hepatology, IBD Clinical Research Program, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Katie O'Connor
- Division of Gastroenterology and Hepatology, IBD Clinical Research Program, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Ajani Jeyakumar
- Division of Gastroenterology and Hepatology, IBD Clinical Research Program, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Parul Tandon
- Division of Gastroenterology and Hepatology, IBD Clinical Research Program, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Geoffrey C Nguyen
- Division of Gastroenterology and Hepatology, IBD Clinical Research Program, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Cynthia Maxwell
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Vivian Huang
- Division of Gastroenterology and Hepatology, IBD Clinical Research Program, Mount Sinai Hospital, Sinai Health System, University of Toronto, Suite 441 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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12
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Burisch J, Zhao M, Odes S, De Cruz P, Vermeire S, Bernstein CN, Kaplan GG, Duricova D, Greenberg D, Melberg HO, Watanabe M, Ahn HS, Targownik L, Pittet VEH, Annese V, Park KT, Katsanos KH, Høivik ML, Krznaric Z, Chaparro M, Loftus EV, Lakatos PL, Gisbert JP, Bemelman W, Moum B, Gearry RB, Kappelman MD, Hart A, Pierik MJ, Andrews JM, Ng SC, D'Inca R, Munkholm P. The cost of inflammatory bowel disease in high-income settings: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2023; 8:458-492. [PMID: 36871566 DOI: 10.1016/s2468-1253(23)00003-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/06/2023]
Abstract
The cost of caring for patients with inflammatory bowel disease (IBD) continues to increase worldwide. The cause is not only a steady increase in the prevalence of Crohn's disease and ulcerative colitis in both developed and newly industrialised countries, but also the chronic nature of the diseases, the need for long-term, often expensive treatments, the use of more intensive disease monitoring strategies, and the effect of the diseases on economic productivity. This Commission draws together a wide range of expertise to discuss the current costs of IBD care, the drivers of increasing costs, and how to deliver affordable care for IBD in the future. The key conclusions are that (1) increases in health-care costs must be evaluated against improved disease management and reductions in indirect costs, and (2) that overarching systems for data interoperability, registries, and big data approaches must be established for continuous assessment of effectiveness, costs, and the cost-effectiveness of care. International collaborations should be sought out to evaluate novel models of care (eg, value-based health care, including integrated health care, and participatory health-care models), as well as to improve the education and training of clinicians, patients, and policy makers.
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Affiliation(s)
- Johan Burisch
- Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark.
| | - Mirabella Zhao
- Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Selwyn Odes
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Melbourne, VIC, Australia; Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Severine Vermeire
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium; Faculty of Medicine, KU Leuven University, Leuven, Belgium
| | - Charles N Bernstein
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Dana Duricova
- IBD Clinical and Research Centre for IBD, ISCARE, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hans O Melberg
- Department of Community Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Mamoru Watanabe
- Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Laura Targownik
- Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Valérie E H Pittet
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Vito Annese
- Division of Gastroenterology, Department of Internal Medicine, Fakeeh University Hospital, Dubai, United Arab Emirates
| | - K T Park
- Stanford Health Care, Packard Health Alliance, Alameda, CA, USA; Genentech (Roche Group), South San Francisco, CA, USA
| | - Konstantinos H Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Marte L Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Zagreb, Zagreb, Croatia
| | - María Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Montreal, QC, Canada; Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Willem Bemelman
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Bjorn Moum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael D Kappelman
- Division of Pediatric Gastroenterology, Department of Pediatrics and Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ailsa Hart
- IBD Unit, St Mark's Hospital, Middlesex, UK
| | - Marieke J Pierik
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jane M Andrews
- IBD Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Siew C Ng
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Renata D'Inca
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Pia Munkholm
- Department of Gastroenterology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
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13
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Jactel SN, Olson JM, Wolin KY, Brown J, Pathipati MP, Jagiella VJ, Korzenik JR. Efficacy of a Digital Personalized Elimination Diet for the Self-Management of Irritable Bowel Syndrome and Comorbid Irritable Bowel Syndrome and Inflammatory Bowel Disease. Clin Transl Gastroenterol 2023; 14:e00545. [PMID: 36322404 PMCID: PMC9875997 DOI: 10.14309/ctg.0000000000000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Most patients with irritable bowel syndrome (IBS) and dual-diagnosis IBS and inflammatory bowel disease (IBD) report that symptoms originate from or are exacerbated by trigger foods. Despite patient interest and need, there is no consensus on what diet is optimal. Popular diets have notable limitations including cost, length, implementation complexity, and lack of personalization. METHODS This pilot study evaluated the feasibility, desirability, and effect on gastrointestinal symptoms of a digitally delivered personalized elimination diet for patients with IBS and comorbid IBS/IBD, powered by machine learning. Participants were recruited online and were provided access to a digital personalized nutrition tool for 9 weeks (N = 37; IBS only = 16, Crohn's disease and IBS = 9, and ulcerative colitis and IBS = 12). RESULTS Significant symptom improvement was seen for 81% of participants at study midpoint and persisted for 70% at end point, measured by the relevant symptom severity score (IBS symptom severity score, Patient Simple Clinical Colitis Activity Index, or Mobile Health Index for Crohn's disease). Clinically significant symptom improvement was observed in 78% of participants at midpoint and 62% at end point. Twenty-five participants (67.6%) achieved total symptomatic resolution by the end of study. Patient-reported quality of life improved for 89% of participants. Ninety-five percentage daily engagement, 95% retention, 89% adherence and 92% satisfaction with the program were reported. DISCUSSION Dietary elimination can improve symptoms and quality of life in patients with IBS and comorbid IBS/IBD. Digital technology can personalize dietary interventions and improve adherence. Randomized controlled trials are warranted.
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Affiliation(s)
- Samuel N. Jactel
- Ayble Health, Boston, Massachusetts, USA
- Kellogg School of Management, Northwestern University, Evanston, Illinois, USA
| | - Joseph M. Olson
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Kathleen Y. Wolin
- Kellogg School of Management, Northwestern University, Evanston, Illinois, USA
| | - Jordan Brown
- Department of Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mythili P. Pathipati
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Joshua R. Korzenik
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
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14
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Cox SR, Czuber-Dochan W, Wall CL, Clarke H, Drysdale C, Lomer MC, Lindsay JO, Whelan K. Improving Food-Related Quality of Life in Inflammatory Bowel Disease through a Novel Web Resource: A Feasibility Randomised Controlled Trial. Nutrients 2022; 14:nu14204292. [PMID: 36296976 PMCID: PMC9611328 DOI: 10.3390/nu14204292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Food-related quality of life (FR-QoL) is impaired in inflammatory bowel disease (IBD) and education and support on food-related issues in IBD is needed. This feasibility trial aimed to investigate the effectiveness and acceptability of a web resource in enhancing FR-QoL in newly diagnosed IBD. Patients diagnosed with Crohn's disease or ulcerative colitis in the preceding 12 months, with an impaired FR-QoL, were recruited and randomised to either receive access to the web resource (covering IBD-specific diet concerns) or no access (control group) for 12 weeks, while receiving usual clinical care. FR-QoL, health-related quality of life, psychological outcomes, and clinical disease activity were assessed. Web resource usage was assessed, and patients' experiences of the web resource were investigated in semi-structured interviews. Of 81 patients screened, 50 participants were randomised, 30 to the web resource and 20 to control. FR-QoL increased more in the web resource (+11.7 SD 18.2) than control group (+1.4 SD 20.4) (p = 0.067), while IBD distress reduced in the web resource (-6.8 SD 26.6) and increased in the control group (+8.3 SD 25.5) (p = 0.052), albeit not statistically significantly. End of trial Crohn's disease clinical activity (PRO-2) was significantly lower in the web resource than control group (p = 0.046). Participants most frequently accessed web resource content discussing dietary management of gut symptoms and in semi-structured interviews, reported the website to contain relevant information. This feasibility study demonstrates potential effectiveness of the web resource on improving FR-QoL and psychological outcomes in IBD. An adequately powered effectiveness RCT is feasible to conduct and is now warranted. NCT03884686.
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Affiliation(s)
- Selina R. Cox
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Wladyslawa Czuber-Dochan
- Midwifery and Palliative Care, Florence Nightingale Faculty of Nursing, King’s College London, London SE1 8WA, UK
| | - Catherine L. Wall
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Hazel Clarke
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Candice Drysdale
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Miranda C. Lomer
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
- Departments of Gastroenterology and Dietetics, Guy’s & St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - James O. Lindsay
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
- Correspondence:
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15
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Storan D, Lavelle J, Burke AM, Hamzawi M, Brett-Kilmurray O, De Dominicis N, McHugh L, Mulcahy HE. Satisfaction with telemedicine-delivered inflammatory bowel disease care depends on disease activity, personality and economic factors. Frontline Gastroenterol 2022; 14:132-137. [PMID: 36818801 PMCID: PMC9933585 DOI: 10.1136/flgastro-2022-102198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/31/2022] [Indexed: 02/24/2023] Open
Abstract
Objective Patients with inflammatory bowel disease (IBD) traditionally receive follow-up care at face-to-face outpatient clinics. During the COVID-19 pandemic, gastroenterology societies recommended IBD clinics to be carried out remotely where possible using telephone or telemedicine-delivered virtual clinics. Previous studies have demonstrated patient satisfaction with virtual clinics but few studies have examined factors that impact satisfaction or assessed patient's personal perception of the virtual clinic experience. Design/method Patients who had their IBD clinic appointment changed from face-to-face to telephone virtual clinic completed a questionnaire relating to their clinical experience and preference for future care. Qualitative data were also collected and evaluated using content analysis to identify major themes associated with the patient experience. Results 141 patients were included for analysis. The virtual clinic satisfaction questionnaire was found to be valid while patients expressed high-satisfaction levels with virtual clinics (median satisfaction score 18, range 0-20). Multivariate analysis identified open personality type (p=0.004), short disease duration (p=0.047) and higher cost to attend clinic (p=0.047) as predictors of high-satisfaction levels, with active disease (p=0.035) and an agreeable personality type (p=0.042) associated with low satisfaction levels. Content analysis of the qualitative data identified three major themes connected to virtual clinic convenience, lack of physical interaction and disease activity. Conclusion Patients expressed high levels of satisfaction with telemedicine-delivered IBD clinics, with most wishing to continue their use. Personality type should be recognised as an important variable affecting clinical satisfaction, in addition to socioeconomic and disease-related factors.
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Affiliation(s)
- Darragh Storan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Joseph Lavelle
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Anne-Marie Burke
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Mary Hamzawi
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Orna Brett-Kilmurray
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Noemi De Dominicis
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Louise McHugh
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Hugh E Mulcahy
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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16
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Appel CW, Pedersen SC, Nielsen AS, Larsen BF. Telemedicine based on patient-reported outcomes in management of patients with inflammatory bowel disease in a real-life setting - a before and after cohort study. Scand J Gastroenterol 2022; 57:825-831. [PMID: 35195491 DOI: 10.1080/00365521.2022.2041083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Avoidable appointments and increasing incidence of inflammatory bowel disease (IBD) call for alternative ways of organizing outpatient visits. In controlled studies, telemedicine including patient reported outcome (PRO) has shown to improve outcomes in IBD and reduce health care utilization. However, we lack studies of telemedicine implemented in everyday practice. We therefore described use of a PRO-based telemedicine follow-up (AmbuIBD) in a real-life setting and investigated the effect on outpatient visits and hospital admissions. METHODS We conducted a cohort study including patients with IBD in an outpatient clinic at a Danish regional hospital August 2018. Data included extracts from the Patient Administration System and the AmbuFlex system between 2017 and August 2018, plus questionnaire data from clinicians. Descriptive statistics were used to describe use of AmbuIBD and differences between before and after results were tested with Wilcoxon's signed-rank test. RESULTS Of 848 patients in outpatient care, 77% were included in AmbuIBD. Most patients were set to answer a PRO questionnaire once a year (n = 407, 62%), and 66% of 1913 answered questionnaires were handled with no further contact. AmbuIBD was well accepted by clinicians. Outpatient visits the year after AmbuIBD compared to the year before were reduced with 14% (p ≤ .001). The largest reduction was for patients with mild or no disease activity (45%, p ≤ .001). No difference was found for hospital admissions. CONCLUSIONS AmbuIBD is feasible and well accepted when implemented in an outpatient clinic. More than half of patients are only followed by questionnaire, and we found a reduction in outpatient visits.
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Affiliation(s)
- Charlotte W Appel
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Sarah Christine Pedersen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Amalie Søgaard Nielsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,School of Health and Social Development, Deakin University, Burwood, Australia
| | - Birgit Furstrand Larsen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
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17
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Utilization and Effectiveness of eHealth Technology in the Follow-up of Celiac Disease: A Systematic Review. J Pediatr Gastroenterol Nutr 2022; 74:812-818. [PMID: 35849504 DOI: 10.1097/mpg.0000000000003423] [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: 12/10/2022]
Abstract
OBJECTIVES To systematically review the literature on the utilization and effectiveness of electronic-health technologies (eHealth), such as smartphone applications, in managing patients with celiac disease (CD). METHODS PubMed, Scopus, and the Cochrane Library were all searched (until February 2021). Inclusion criteria were full-text English articles reporting original data on the use of eHealth technologies in the follow-up of CD patients, with no age restriction. Exclusion criteria were studies only using non-interactive websites and phone consultation as the primary eHealth method. The results were summarized narratively. RESULTS Using identified keywords, 926 unique studies were identified. After title and abstract screening by two independent reviewers, 26 studies were reviewed in full text. Finally, eight studies were included in this systematic review, and their quality appraised using standardized forms. Of the eight studies, six were randomized-controlled trials, one mixed-methods study, and one cross-sectional, observational study. Studies were assessed to be of "low" to "moderate" methodological quality. Studied eHealth technologies included web-based interventions, smartphone applications, text messaging, and online consultations. The most consistently reported effects related to improved quality of life (number of studies = 4), knowledge on CD (n = 3), and dietary adherence (n = 2); notably, only one study reported reduced costs of eHealth vs. standard (in-office) care. CONCLUSIONS Although eHealth has the potential to improve the management of CD, so far, the research in the field is scarce and generally of low-moderate methodological quality. Hence, the effectiveness of eHealth in CD management remains uncertain, and more high-quality evidence is required before its utility is known.
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18
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Sweeney L, Windgassen S, Artom M, Norton C, Fawson S, Moss-Morris R. A Novel Digital Self-management Intervention for Symptoms of Fatigue, Pain, and Urgency in Inflammatory Bowel Disease: Describing the Process of Development. JMIR Form Res 2022; 6:e33001. [PMID: 35583924 PMCID: PMC9161057 DOI: 10.2196/33001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Empirical studies and systematic reviews have demonstrated the role of biological, cognitive, behavioral, and emotional factors in fatigue, pain, and urgency in inflammatory bowel disease (IBD). Behavioral management that addresses the cognitive, behavioral, and emotional factors offered alongside medical treatment is seldom available to people with IBD. Digital interventions provide a potentially scalable and cost-effective way of providing behavioral support to patients. Objective This paper aimed to describe the process of developing a supported digital self-management intervention for fatigue, pain, and urgency in IBD using theory and evidence-based approaches and stakeholder input. Methods The Medical Research Council framework for complex health interventions and a person-based approach were used to guide intervention development, consulting with 87 patients with IBD and 60 nurses. These frameworks informed the selection and use of a theoretical model that subsequently guided cognitive behaviorally based intervention content. They also guided the design of tailored digital intervention pathways for individuals with IBD that matched the predominant symptoms. Results A transsymptomatic cognitive behavioral framework of symptom perpetuation was developed for the symptoms of fatigue, pain, and urgency in IBD. A logic model was used to define the intervention techniques. Patient feedback and qualitative interviews refined the website content and functionalities, including the use of visual aids, email reminders, and graphical tracking of symptoms. Nurse focus groups informed the volume and delivery model of the therapist facilitator support. Ratings of acceptability out of 10 following feasibility testing (31/87, 36%) demonstrated accessibility (scoring 9.43, SD 1.040), ease (scoring 8.07, SD 3.205), clarity, and the relevant tone of the intervention. The final intervention comprised 12 web-based sessions (8 core and 4 symptom-specific), with one 30-minute facilitator phone call following session 1 and subsequent on-site messaging. Conclusions The use of theory and integration of stakeholders’ views throughout informed the development of an evidence-based digital intervention for fatigue, pain, and urgency in IBD. This is the first web-based self-management intervention designed to address these multiple symptoms with the aim of improving the quality of life and reducing the symptom burden of IBD. The intervention is being tested in a large multicenter randomized controlled trial. Trial Registration ISRCTN Registry ISRCTN71618461; https://www.isrctn.com/ISRCTN71618461
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Affiliation(s)
- Louise Sweeney
- Health Psychology Section, King's College London, London, United Kingdom
| | - Sula Windgassen
- Health Psychology Section, King's College London, London, United Kingdom
| | | | - Christine Norton
- Health Psychology Section, King's College London, London, United Kingdom
| | - Sophie Fawson
- Health Psychology Section, King's College London, London, United Kingdom
| | - Rona Moss-Morris
- Health Psychology Section, King's College London, London, United Kingdom
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Rohde JA, Fisher EB, Boynton MH, Freelon D, Frohlich DO, Barnes EL, Noar SM. A Self-management SMS Text Messaging Intervention for People With Inflammatory Bowel Disease: Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e34960. [PMID: 35522471 PMCID: PMC9123538 DOI: 10.2196/34960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/04/2022] [Accepted: 04/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile health technologies can be useful for providing disease self-management information and support to people with inflammatory bowel disease (IBD). OBJECTIVE The aim of this study was to test a self-management SMS text messaging intervention for people with IBD. Our goal was to examine intervention feasibility, acceptability, and engagement and to preliminarily evaluate improvements in certain self-reported health outcomes among participants. METHODS We developed an SMS text messaging program called Text4IBD. The program sent daily support messages and resources about disease self-management over the course of a 2-week, single-group, pretest-posttest intervention to participants (N=114) diagnosed with IBD. We examined intervention feasibility, acceptability, and engagement through Text4IBD message topic recall and use of resources (ie, visiting supplemental websites recommended by the Text4IBD program). We also assessed pretest-posttest measures of IBD-related distress, self-efficacy, perceived support, use of coping strategies, and medication adherence. Analyses examined participants' evaluations of the intervention and compared pretest-posttest changes in secondary outcomes using paired-samples statistics. RESULTS Approximately all participants who completed the intervention (n=105) were receptive to Text4IBD and viewed the program as feasible and acceptable. In addition, most participants (103/105, 98.1%) recalled at least one of the message topics sent by the program, and 79% (83/105) of them self-reported engaging with at least one of the external self-management resources recommended by the Text4IBD program. Pretest-posttest results showed reduced IBD-related distress (mean 3.33, SD 0.68 vs mean 2.86, SD 0.73; P<.001) and improvements in most other secondary outcomes. CONCLUSIONS Findings from this study highlight the value of SMS text messaging as a useful digital medium for providing support to people with IBD, particularly to those who may struggle with disease-related distress. Text4IBD was highly feasible and acceptable and may help people self-manage their IBD. Future studies should aim to evaluate this program in a randomized controlled trial in clinical settings.
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Affiliation(s)
- Jacob A Rohde
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Edwin B Fisher
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marcella H Boynton
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Deen Freelon
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dennis O Frohlich
- Department of Media and Journalism, Bloomsburg University of Pennsylvania, Bloomsburg, PA, United States
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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20
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French experience with telemedicine in inflammatory bowel disease: a patients and physicians survey. Eur J Gastroenterol Hepatol 2022; 34:398-404. [PMID: 34860706 DOI: 10.1097/meg.0000000000002319] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS The use of telemedicine dramatically increased during the COVID-19 pandemic. We collected patients and physicians experience on telemedicine in the field of inflammatory bowel disease (IBD). METHODS We conducted a nationwide survey between September 2020 and January 2021. A self-administered questionnaire was sent to participants through mailing lists of the national patients' association and IBD expert groups. RESULTS Overall, 300 patients and 110 gastroenterologists filled out the survey. On a 10 points scale of satisfaction with telemedicine, 60% of patients noted a score ≥8 and 52.7% of physicians ≥7. Patients and gastroenterologists felt that the duration of teleconsultations appeared to be shorter than in-person visits in 57.5 and 55.1% of cases, respectively. All participants agreed that telemedicine is appropriate in dedicated situations and not for flare-up consultations. For 55.1% of patients, quality of care was the same via telemedicine, whereas 51.4% of gastroenterologists believed they managed less well their patients. Lack of clinical examination being pointed out as the main limitation of telemedicine. Three-quarters of patients and gastroenterologists would agree to use telemedicine more often in the future. CONCLUSION Patients and gastroenterologists were satisfied with telemedicine and would be willing to use it in the future. However, telemedicine does not replace in-person visits and should be discussed on a case-by-case basis.
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Pang L, Liu H, Liu Z, Tan J, Zhou LY, Qiu Y, Lin X, He J, Li X, Lin S, Ghosh S, Mao R, Chen M. Role of Telemedicine in Inflammatory Bowel Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e28978. [PMID: 35323120 PMCID: PMC8990345 DOI: 10.2196/28978] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 10/14/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Telemedicine plays an important role in the management of inflammatory bowel disease (IBD), particularly during a pandemic such as COVID-19. However, the effectiveness and efficiency of telemedicine in managing IBD are unclear. OBJECTIVE This systematic review and meta-analysis aimed to compare the impact of telemedicine with that of standard care on the management of IBD. METHODS We systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases on April 22, 2020. Randomized controlled trials comparing telemedicine with standard care in patients with IBD were included, while conference abstracts, letters, reviews, laboratory studies, and case reports were excluded. The IBD-specific quality of life (QoL), disease activity, and remission rate in patients with IBD were assessed as primary outcomes, and the number of in-person clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were assessed as secondary outcomes. Review Manage 5.3 and Stata 15.1 were used for data analysis. RESULTS A total of 17 randomized controlled trials (2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group (standard mean difference 0.18, 95% CI 0.01 to 0.34; P.03). The number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (standard mean difference -0.71, 95% CI -1.07 to -0.36; P<.001). Subgroup analysis showed that adolescents in the telemedicine group had significantly higher IBD-specific QoL than those in the standard care group (standard mean difference 0.42, 95% CI 0.15 to 0.69; I2=0; P.002), but there was no significant difference between adults in the 2 groups. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between the telemedicine and standard care groups. CONCLUSIONS Telemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits among patients with IBD. Further research is warranted to identify the group of patients with IBD who would most benefit from telemedicine.
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Affiliation(s)
- Lanlan Pang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Hengyu Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhidong Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jinyu Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Long-Yuan Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoqing Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinshen He
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuehua Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sinan Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Subrata Ghosh
- NIHR Biomedical Research Centre, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Chamorro-de-Vega E, Romero-Jiménez R, Escudero-Vilaplana V, Ais-Larisgoitia A, Lobato Matilla ME, González CM, Menchén L, Baniandrés O, Ibares-Frias L, Lobo-Rodríguez C, Herranz-Alonso A, Sanjurjo M. Information and communication technologies in Patients with Immune-Mediated Inflammatory Diseases: Cross-Sectional Survey (Preprint). J Med Internet Res 2022; 24:e37445. [PMID: 36099018 PMCID: PMC9516367 DOI: 10.2196/37445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Information and communication technologies (ICTs) are changing the traditional health care model and redefining personalized health. ICTs offer effective communication and real-time monitoring of patients and provide additional data to support clinical decision-making, improve the quality of care, and contribute to the empowerment of patients. However, evidence on the use of ICTs and digital preferences of immune-mediated inflammatory disease (IMID) patients is scarce. Objective The aim of this study is to describe the degree of use of ICTs in patients with IMIDs (including rheumatic diseases, inflammatory bowel diseases, and psoriasis), identify their needs, and analyze their interest in the use of apps as tools for better management of their disease. Methods A questionnaire was created by a multidisciplinary team including pharmacists, rheumatologists, gastroenterologists, dermatologists, and nurses with experience in ICTs applied to the field of IMID. The survey included 27 questions organized into 3 blocks: (1) sociodemographic characteristics, (2) ICT use for health-related information, and (3) patient expectations about mobile health. Results A total of 472 questionnaires were analyzed. Overall, 52.9% (250/472) of patients were diagnosed with a rheumatologic disease, 39.4% (186/472) with inflammatory bowel disease, and 12.3% (58/472) with psoriasis. The state of health was considered good by 45.6% (215/472) of patients. Patients were interested in staying informed about health issues in 86.9% (410/427) of cases and sought health-related information mainly from the internet (334/472, 70.8%) and health care professionals (318/472, 67.4%). Overall, 13.6% (64/472) did not trust the health information they found in internet. Of the patients, 42.8% (202/472) had a health app, and 42.2% (199/472) had found it on their own. Patients would like a health app to help mainly to manage appointments (281/472, 59.5%), obtain information about their diseases and treatments (274/472, 58.1%), and get in contact with health professionals (250/472, 53.0%). Overall, 90.0% (425/472) of patients reported they would use an app to manage their IMID if their health professional recommended it, and 58.0% (274/472) would pay or probably be willing to pay for it. Conclusions IMID patients were very interested in finding health-related information via ICTs, especially using smartphones and apps recommended by health professionals. Appointment management, advice on disease and treatment management, and personalized communication with health professionals were the most desired app features identified. Health professionals should play an essential role in recommending and validating these tools to ensure they are of high quality.
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Affiliation(s)
- Esther Chamorro-de-Vega
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rosa Romero-Jiménez
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Arantza Ais-Larisgoitia
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Elena Lobato Matilla
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carlos M González
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Luis Menchén
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Ofelia Baniandrés
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Lucía Ibares-Frias
- Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carmen Lobo-Rodríguez
- Nursing Group, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Herranz-Alonso
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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van Erp LW, Groenen MJM, Heida W, Wisse J, Roosenboom B, Wahab PJ. Mobile application to monitor inflammatory bowel disease patients on intravenous biologic treatment: a feasibility study. Scand J Gastroenterol 2021; 56:1414-1421. [PMID: 34448665 DOI: 10.1080/00365521.2021.1966832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Monitoring of IBD patients on intravenous biologic treatment is recommended but time-consuming for patients and nurses. We developed a mobile application (app) to promote self-management and studied its feasibility in clinical practice. METHODS Adult IBD patients treated with intravenous infliximab or vedolizumab used the app over four biologic treatments. The app includes information modules and an interactive timeline with notifications of blood tests and health checks before treatment. RESULTS In total, 55 patients participated of whom 71% had Crohn's disease and 85% used infliximab. Compliance with health checks and blood tests was 67% before the first biologic treatment and 70, 87, and 80% before the second, third, and fourth treatment, respectively. The median number of times the app was used per treatment varied from 6 to 8 times (≥4 considered sufficient). Patients were satisfied with the app [median VAS score 8 (IQR 7-9)] and remained equally satisfied with IBD care [score 8 (IQR 8-9) before and after app use]. Nurses contacted all patients by telephone before the first biologic treatment, as previous standard care. Before the second, third, and fourth treatment only 47, 35, and 49% of patients were contacted. The majority (92%) wanted to continue using the app after the study. CONCLUSIONS Monitoring of IBD patients treated with intravenous biologics using an app is feasible. We saw high compliance, sufficient app use, and high patient satisfaction. Moreover, health-care utilization was reduced and almost all patients preferred using the app over previous standard care (ClinicalTrials.gov NCT04254614).
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Affiliation(s)
- Liselot W van Erp
- Department of Gastroenterology and Hepatology, Crohn & Colitis Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marcel J M Groenen
- Department of Gastroenterology and Hepatology, Crohn & Colitis Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Wendy Heida
- Department of Gastroenterology and Hepatology, Crohn & Colitis Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jolien Wisse
- Department of Gastroenterology and Hepatology, Crohn & Colitis Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Britt Roosenboom
- Department of Gastroenterology and Hepatology, Crohn & Colitis Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Peter J Wahab
- Department of Gastroenterology and Hepatology, Crohn & Colitis Centre, Rijnstate Hospital, Arnhem, The Netherlands
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The effect of a nurse-led advice line and virtual clinic on inflammatory bowel disease service delivery: an Australian study. Eur J Gastroenterol Hepatol 2021; 33:e771-e776. [PMID: 34402467 DOI: 10.1097/meg.0000000000002249] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND This retrospective cohort study investigated the economic impact of implementing a nurse-led inflammatory bowel disease (IBD) advice-line and virtual clinic on the Australian healthcare system. The advice line is a telephone and email service managed by IBD specialist nurses. The virtual clinic is a planned, formal communication between the gastroenterologist and the specialist IBD nurse the result of which is communicated to the patient electronically. METHODS Advice line telephone calls and virtual clinic consultations registered between 1 June 2015 and 1 June 2016 were reviewed and analyzed in terms of outcome: avoidance of general practitioner (GP) consultation, IBD outpatient consultation, emergency department (ED) presentation, or hospital admission. Cost-benefit analysis was conducted to estimate financial savings. RESULTS During the study period, 220 calls were received through the advice line and 1017 virtual clinic consultations occurred. The advice line resulted in the avoidance of 53 GP visits, 159 IBD outpatient department visits, six ED presentations, and one hospital admission. The virtual clinic resulted in the avoidance of four GP visits, 954 IBD outpatient department visits, and 58 ED presentations. This led to an estimated annual cost saving of AUD 169 376.80, with the annual costs incurred estimated to be $58 713. Thus, the annual net benefit of implementing the advice line and the virtual clinic was estimated to be $110 663.80. CONCLUSION Specialized-IBD-nurse-led advice line and virtual clinic improves IBD patients' access to services and reduces healthcare costs. This highlights the importance of a proactive multidisciplinary approach in optimizing the care of patients with IBD.
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Nick JM, Roberts LR, Petersen AB. Effectiveness of telemonitoring on self-care behaviors among community-dwelling adults with heart failure: a quantitative systematic review. JBI Evid Synth 2021; 19:2659-2694. [PMID: 33896907 PMCID: PMC8528136 DOI: 10.11124/jbies-20-00329] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This review examined the effectiveness of telemonitoring versus usual care on self-care behaviors among community-dwelling adults with heart failure. INTRODUCTION Heart failure is a global health crisis. There is a body of high-level evidence demonstrating that telemonitoring is an appropriate and effective therapy for many chronic conditions, including heart failure. The focus has been on traditional measures such as rehospitalizations, length of stay, cost analyses, patient satisfaction, quality of life, and death rates. What has not been systematically evaluated is the effectiveness of telemonitoring on self-care behaviors. Involving patients in self-care is an important heart failure management strategy. INCLUSION CRITERIA This review included studies on adult participants (18 years and older), diagnosed with heart failure (New York Heart Association Class I - IV), who used telemonitoring in the ambulatory setting. Studies among pediatric patients with heart failure, adult patients with heart failure in acute care settings, or those residing in a care facility were excluded. METHODS Eight databases, including CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Epistemonikos, ProQuest Dissertations and Theses, PsycINFO, and Web of Science were systematically searched for English-language studies between 1997 and 2019. Studies selected for retrieval were assessed by two independent reviewers for methodological quality using critical appraisal checklists appropriate to the study design. Those meeting a priori quality standards of medium or high quality were included in the review. RESULTS Twelve publications were included in this review (N = 1923). Nine of the 12 studies were randomized controlled trials and three were quasi-experimental studies. Based on appropriate JBI critical appraisal tools, the quality of included studies was deemed moderate to high. In a majority of the studies, a potential source of bias was related to lack of blinding of treatment assignment. Telemonitoring programs ranged from telephone-based support, interactive websites, and mobile apps to remote monitoring systems and devices. Self-care outcomes were measured with the European Heart Failure Self-care Behaviour Scale in nine studies and with the Self-care of Heart Failure Index in three studies. Telemonitoring improved self-care behaviors across 10 of these studies, achieving statistical significance. Clinical significance was also observed in nine of the 12 studies. All studies utilized one of two validated instruments that specifically measure self-care behaviors among patients with heart failure. However, in some studies, variation in interpretation and reporting was observed in the use of one instrument. CONCLUSIONS Overall, telemonitoring had a positive effect on self-care behavior among adult, community-dwelling patients with heart failure; however, there is insufficient and conflicting evidence to determine how long the effectiveness lasts. Longitudinal studies are needed to determine the sustained effect of telemonitoring on self-care behaviors. In addition, the limitations of the current studies (eg, inadequate sample size, study design, incomplete statistical reporting, self-report bias) should be taken into account when designing future studies. This review provides evidence for the use of telemonitoring, which is poised for dramatic expansion given the current clinical environment encouraging reduced face-to-face visits. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019131852.
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Affiliation(s)
- Jan M Nick
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
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Majidova K, Handfield J, Kafi K, Martin RD, Kubinski R. Role of Digital Health and Artificial Intelligence in Inflammatory Bowel Disease: A Scoping Review. Genes (Basel) 2021; 12:1465. [PMID: 34680860 PMCID: PMC8535572 DOI: 10.3390/genes12101465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel diseases (IBD), subdivided into Crohn's disease (CD) and ulcerative colitis (UC), are chronic diseases that are characterized by relapsing and remitting periods of inflammation in the gastrointestinal tract. In recent years, the amount of research surrounding digital health (DH) and artificial intelligence (AI) has increased. The purpose of this scoping review is to explore this growing field of research to summarize the role of DH and AI in the diagnosis, treatment, monitoring and prognosis of IBD. A review of 21 articles revealed the impact of both AI algorithms and DH technologies; AI algorithms can improve diagnostic accuracy, assess disease activity, and predict treatment response based on data modalities such as endoscopic imaging and genetic data. In terms of DH, patients utilizing DH platforms experienced improvements in quality of life, disease literacy, treatment adherence, and medication management. In addition, DH methods can reduce the need for in-person appointments, decreasing the use of healthcare resources without compromising the standard of care. These articles demonstrate preliminary evidence of the potential of DH and AI for improving the management of IBD. However, the majority of these studies were performed in a regulated clinical environment. Therefore, further validation of these results in a real-world environment is required to assess the efficacy of these methods in the general IBD population.
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Affiliation(s)
| | | | | | | | - Ryszard Kubinski
- Phyla Technologies Inc., Montréal, QC H3C 4J9, Canada; (K.M.); (J.H.); (K.K.); (R.D.M.)
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Knapp A, Harst L, Hager S, Schmitt J, Scheibe M. Use of Patient-reported Outcome Measures and Patient-reported Experience Measures within Evaluation Studies of Telemedicine Applications: Systematic Review. J Med Internet Res 2021; 23:e30042. [PMID: 34523604 PMCID: PMC8663685 DOI: 10.2196/30042] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/06/2021] [Accepted: 09/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background With the rise of digital health technologies and telemedicine, the need for evidence-based evaluation is growing. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are recommended as an essential part of the evaluation of telemedicine. For the first time, a systematic review has been conducted to investigate the use of PROMs and PREMs in the evaluation studies of telemedicine covering all application types and medical purposes. Objective This study investigates the following research questions: in which scenarios are PROMs and PREMs collected for evaluation purposes, which PROM and PREM outcome domains have been covered and how often, which outcome measurement instruments have been used and how often, does the selection and quantity of PROMs and PREMs differ between study types and application types, and has the use of PROMs and PREMs changed over time. Methods We conducted a systematic literature search of the MEDLINE and Embase databases and included studies published from inception until April 2, 2020. We included studies evaluating telemedicine with patients as the main users; these studies reported PROMs and PREMs within randomized controlled trials, controlled trials, noncontrolled trials, and feasibility trials in English and German. Results Of the identified 2671 studies, 303 (11.34%) were included; of the 303 studies, 67 (22.1%) were feasibility studies, 70 (23.1%) were noncontrolled trials, 20 (6.6%) were controlled trials, and 146 (48.2%) were randomized controlled trials. Health-related quality of life (n=310; mean 1.02, SD 1.05), emotional function (n=244; mean 0.81, SD 1.18), and adherence (n=103; mean 0.34, SD 0.53) were the most frequently assessed outcome domains. Self-developed PROMs were used in 21.4% (65/303) of the studies, and self-developed PREMs were used in 22.3% (68/303). PROMs (n=884) were assessed more frequently than PREMs (n=234). As the evidence level of the studies increased, the number of PROMs also increased (τ=−0.45), and the number of PREMs decreased (τ=0.35). Since 2000, not only has the number of studies using PROMs and PREMs increased, but the level of evidence and the number of outcome measurement instruments used have also increased, with the number of PREMs permanently remaining at a lower level. Conclusions There have been increasingly more studies, particularly high-evidence studies, which use PROMs and PREMs to evaluate telemedicine. PROMs have been used more frequently than PREMs. With the increasing maturity stage of telemedicine applications and higher evidence level, the use of PROMs increased in line with the recommendations of evaluation guidelines. Health-related quality of life and emotional function were measured in almost all the studies. Simultaneously, health literacy as a precondition for using the application adequately, alongside proper training and guidance, has rarely been reported. Further efforts should be pursued to standardize PROM and PREM collection in evaluation studies of telemedicine.
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Affiliation(s)
- Andreas Knapp
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Lorenz Harst
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Stefan Hager
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany, Dresden, DE
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Madlen Scheibe
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
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da Fonseca MH, Kovaleski F, Picinin CT, Pedroso B, Rubbo P. E-Health Practices and Technologies: A Systematic Review from 2014 to 2019. Healthcare (Basel) 2021; 9:healthcare9091192. [PMID: 34574966 PMCID: PMC8470487 DOI: 10.3390/healthcare9091192] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/17/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
E-health can be defined as a set of technologies applied with the help of the internet, in which healthcare services are provided to improve quality of life and facilitate healthcare delivery. As there is a lack of similar studies on the topic, this analysis uses a systematic literature review of articles published from 2014 to 2019 to identify the most common e-health practices used worldwide, as well as the main services provided, diseases treated, and the associated technologies that assist in e-health practices. Some of the key results were the identification of the four most common practices used (mhealth or mobile health; telehealth or telemedicine; technology; and others) and the most widely used technologies associated with e-health (IoT, cloud computing, Big Data, security, and systems).
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Affiliation(s)
- Maria Helena da Fonseca
- Department of Production Engineering, Federal University of Technology—Paraná (UTFPR), Ponta Grossa 84017-220, Brazil; (F.K.); (C.T.P.)
- Correspondence: ; Tel.: +55-42-999388129
| | - Fanny Kovaleski
- Department of Production Engineering, Federal University of Technology—Paraná (UTFPR), Ponta Grossa 84017-220, Brazil; (F.K.); (C.T.P.)
| | - Claudia Tania Picinin
- Department of Production Engineering, Federal University of Technology—Paraná (UTFPR), Ponta Grossa 84017-220, Brazil; (F.K.); (C.T.P.)
| | - Bruno Pedroso
- Division of Physical Education, State University of Ponta Grossa—Paraná (UEPG), Ponta Grossa 84030-900, Brazil;
| | - Priscila Rubbo
- Department of Accounting Sciences, Federal University of Technology—Paraná (UTFPR), Pato Branco 85503-390, Brazil;
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Rohde JA, Barker JO, Noar SM. Impact of eHealth technologies on patient outcomes: a meta-analysis of chronic gastrointestinal illness interventions. Transl Behav Med 2021; 11:1-10. [PMID: 31731292 DOI: 10.1093/tbm/ibz166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gastrointestinal (GI) illness interventions are increasingly utilizing eHealth technologies, yet little is currently known about the extent of their impact on patient outcomes. The purpose of this study was to conduct a meta-analysis of the GI eHealth intervention literature. We used a comprehensive search strategy to locate studies. To be included, studies had to be a randomized controlled trial comparing an eHealth intervention condition against a no-treatment or waitlist control condition. Studies had to report data on at least one of the following patient outcomes: medication adherence, quality of life (QoL), psychological distress, illness-related knowledge, or number of patient visits to the clinic/hospital. Analyses weighted effect sizes (d) by their inverse variance and combined them using random effects meta-analytic procedures. K = 19 studies conducted in eight countries with a cumulative sample size of N = 3,193 were meta-analyzed. Findings indicated that GI eHealth interventions improved patients' QoL (d = .25, p = .008), psychological distress (d = .24, p = .017), medication adherence (d = .17, p = .014), and illness-related knowledge (d = .19, p = .002). GI eHealth interventions also significantly reduced the number of patient visits to the clinic/hospital (d = .78, p = .005). Our findings suggest that eHealth interventions hold promise in improving patient outcomes for those with GI illnesses. We suggest the next generation of GI interventions continue developing and evaluating the impact of technology using randomized controlled trial designs, and perhaps consider adapting existing efficacious interventions for burgeoning platforms, such as smartphones and tablets.
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Affiliation(s)
- Jacob A Rohde
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua O Barker
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Solitano V, Alfarone L, D'Amico F, Peyrin-Biroulet L, Danese S. IBD goes home: from telemedicine to self-administered advanced therapies. Expert Opin Biol Ther 2021; 22:17-29. [PMID: 34116611 DOI: 10.1080/14712598.2021.1942833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Major challenges have been posed by the coronavirus disease 2019 pandemic in the routine management of patients with inflammatory bowel disease (IBD). The need for constant monitoring of diseases activity and prompt adjustment of therapy have been balanced with the risk of contagion related to face-to-face consultations. Therefore, digital health initiatives have been pursued for safety reasons as vicarious instruments to avoid overcrowding of the IBD clinics. However, concerns and skepticism about the feasibility of digital health and telemedicine modalities limited their uptake in clinical practice in the pre-pandemic period.Areas covered: We conducted a literature overview on the current state of the art and the potential future benefits deriving from the integration of telemedicine systems, home-based laboratory tests, and self-administered drugs into IBD daily practice.Expert opinion: Digital health and telemedicine approaches at distance have been experimented as effective tools to avoid overcrowding of clinics and reduce risk from SARS-CoV2 exposure. Home-based point of care testing, such as fecal calprotectin and dried blood samples, might represent an effective method of remote monitoring of patients particularly when in-person visits are precluded. High expectations are placed on the use of self-administered advanced therapies, such as new subcutaneous formulation of biologics.
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Affiliation(s)
- Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ludovico Alfarone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IBD Center, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IBD Center, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
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Goodsall TM, Han S, Bryant RV. Understanding attitudes, concerns, and health behaviors of patients with inflammatory bowel disease during the coronavirus disease 2019 pandemic. J Gastroenterol Hepatol 2021; 36:1550-1555. [PMID: 33063927 PMCID: PMC7675463 DOI: 10.1111/jgh.15299] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM The coronavirus disease 2019 (COVID-19) pandemic has led to a rapid shift in care delivery models for patients with inflammatory bowel disease (IBD); however, little is known about patient perceptions during this period. We aimed to prospectively evaluate the attitudes, concerns, and health behavior of IBD patients during COVID-19. METHODS An online survey was sent to patients from a tertiary IBD Service. The survey included demographic information and questions about the impact of COVID-19, levels of concern caused by COVID-19, perceived risk of IBD medications, medication cessation, and care delivery preferences. RESULTS Of 97 respondents (39%), 95 (98%) reported concern about the impact of COVID-19 on their health, and 43% felt their risk of contracting COVID-19 was above average; 62% reported concern about medication-induced COVID-19 risk, and 11% stopped medications because of COVID-19. Patients considered all medications to increase the risk of COVID-19 susceptibility and severity; 45% preferred telehealth while 16% preferred face-to-face clinic reviews. Preference for IBD monitoring tools in decreasing order was blood testing, stool collection, gastrointestinal ultrasound, magnetic resonance enterography, and then colonoscopy. CONCLUSIONS Patients with IBD are demonstrated to experience concern related to their diagnosis and medications. The insights provided by the survey are informative for a possible "second-wave" of COVID-19 and routine care, including acceptance of telemedicine, preference for non-invasive investigations, and a need for dissemination of information and education.
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Affiliation(s)
- Thomas M Goodsall
- IBD Service, Department of GastroenterologyThe Queen Elizabeth Hospital,Faculty of Health Sciences, School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Sangwoo Han
- IBD Service, Department of GastroenterologyThe Queen Elizabeth Hospital
| | - Robert V Bryant
- IBD Service, Department of GastroenterologyThe Queen Elizabeth Hospital,Faculty of Health Sciences, School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Nick JM, Petersen AB, Roberts LR. Effect of telemonitoring on self-care behaviors among community-dwelling adults with heart failure: a quantitative systematic review protocol. JBI Evid Synth 2021; 18:1091-1099. [PMID: 32813363 DOI: 10.11124/jbisrir-d-18-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This systematic review seeks to synthesize evidence to determine the effect of telemonitoring on self-care behaviors of adults with heart failure. INTRODUCTION There is a high-level body of evidence demonstrating that telemonitoring is an appropriate and effective therapy for many chronic conditions and, specifically, for patients with heart failure. However, the effect of telemonitoring on self-care behaviors in the adult population with heart failure is unknown. INCLUSION CRITERIA This review will include studies on adult participants (18 years and over) diagnosed with heart failure who use telemonitoring in the ambulatory setting. Studies of pediatric heart failure patients, and adult heart failure patients in acute care settings or in a care facility, will be excluded. METHODS The search for studies will include English language studies published from 1997. Search terms will include heart failure, telemonitoring, self-care, and outpatient/ambulatory care, and will be used in three key sources: CINAHL, Embase, and PubMed. For the full review, Epistomonikos, ProQuest, PsycINFO, and Web of Science will also be searched. Using inclusion/exclusion criteria, two reviewers will select studies based on a three-step process. Methodological quality will be determined using critical appraisal checklists appropriate to the study design. Data extraction will include populations, study designs and methods, interventions, and outcomes related to self-care behaviors. Pooled studies will allow calculation of meta-analysis, while calculated effect sizes and confidence intervals will inform impact and precision of effect. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019131852.
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Affiliation(s)
- Jan M Nick
- School of Nursing, Loma Linda University, Loma Linda, USA
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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: 2.3] [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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Hayrapetian L, Zepp M, Rao S, Hennessey M, Houle M, Atienza M, Belfaqeeh OA, Dharia I, Khan A, Borum ML. Expanding telehealth options during the COVID pandemic eliminated racial and age disparities in electronic communication by inflammatory bowel disease patients. J Natl Med Assoc 2021; 113:474-477. [PMID: 33941370 DOI: 10.1016/j.jnma.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Electronic messaging and telemedicine visits increased during the COVID pandemic. African-Americans and older patients have less frequently used electronic messaging with their physicians. This study compares the utilization of virtual health care before and during the COVID pandemic for inflammatory bowel disease (IBD) patients. METHODS A chart review of all IBD patients seen at an academic medical center from 2014-2020 was conducted to evaluate the use of telehealth options (e-messaging, e-visits) during a pre-COVID and COVID timeframe. Analysis of telehealth use from March - August 2018 and March - August 2020 was performed. Patient age, gender, race, IBD type, electronic messaging and telehealth visits were obtained. A confidential database was created. Statistical analysis was performed using Fisher Exact test with significance set at p < 0.05. The study was IRB approved. RESULTS 392 patients were in the pre-COVID cohort. There were 204 White, 99 African-American, 11 Asian, and 78 racially un-identified patients. 160 (40.8%) initiated E-communication with their physicians. There was a significant difference in the use of e-messaging based upon age (51.1% < 50 vs 39.7% ≥ 50; p = 0.0396) and race (62.3% White vs 28.2% African-American; p < 0.00001).There were no significant differences in the use of e-messaging based upon patient gender (p = 0.6840) or IBD type (p = 0.6374). There were 295 patients in the COVID cohort. There were 155 White, 83 African American patients, 24 Hispanic patients, 10 Asian patients, and 22 racially un-identified patients. 109 (36.9%) utilized a telehealth option (53 via e-messaging; 56 via telemedicine visit). There was no significant difference in the use of a telehealth option based upon age (36.8% < 50 vs 37.25% ≥ 50 years; p = 1.00), race (42.6% White vs 35.9% African-American; p = 0.2693) or IBD type (p = 0.331). Males used telehealth more than females (46.1% vs 29.7%, respectively; p = 0.0051). DISCUSSION The COVID pandemic emergency increased e-visits and e-messaging for care delivery. Expanded telemedicine options for IBD patients eliminated previously identified racial and age disparities in virtual medical care. African Americans utilized electronic communication as frequently as Whites during the pandemic. Post-pandemic policy consideration for continued telemedicine options may expand patient-physician engagement and eliminate disparities in health care.
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Affiliation(s)
- Laurie Hayrapetian
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Molly Zepp
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Sanjana Rao
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Megan Hennessey
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Matthew Houle
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Matthew Atienza
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Omar Ali Belfaqeeh
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Ishaan Dharia
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Ali Khan
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA
| | - Marie L Borum
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington University, Washington, D.C, USA.
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Liu T, Han L, Tilley M, Afzelius L, Maciejewski M, Jelinsky S, Tian C, McIntyre M, Bing N, Hung K, Altman RB. Distinct clinical phenotypes for Crohn's disease derived from patient surveys. BMC Gastroenterol 2021; 21:160. [PMID: 33836648 PMCID: PMC8034169 DOI: 10.1186/s12876-021-01740-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background Defining clinical phenotypes provides opportunities for new diagnostics and may provide insights into early intervention and disease prevention. There is increasing evidence that patient-derived health data may contain information that complements traditional methods of clinical phenotyping. The utility of these data for defining meaningful phenotypic groups is of great interest because social media and online resources make it possible to query large cohorts of patients with health conditions. Methods We evaluated the degree to which patient-reported categorical data is useful for discovering subclinical phenotypes and evaluated its utility for discovering new measures of disease severity, treatment response and genetic architecture. Specifically, we examined the responses of 1961 patients with inflammatory bowel disease to questionnaires in search of sub-phenotypes. We applied machine learning methods to identify novel subtypes of Crohn’s disease and studied their associations with drug responses. Results Using the patients’ self-reported information, we identified two subpopulations of Crohn’s disease; these subpopulations differ in disease severity, associations with smoking, and genetic transmission patterns. We also identified distinct features of drug response for the two Crohn’s disease subtypes. These subtypes show a trend towards differential genotype signatures. Conclusion Our findings suggest that patient-defined data can have unplanned utility for defining disease subtypes and may be useful for guiding treatment approaches. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01740-6.
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Affiliation(s)
- Tianyun Liu
- Department of Bioengineering, Stanford University, Shriram Room 209, MC: 4245, 443 Via Ortega Drive, Stanford, CA, 94305-4145, USA
| | - Lichy Han
- Biomedical Informatics Training Program, Stanford University, Stanford, CA, USA
| | - Mera Tilley
- Inflammation and Immunology, Pfizer Inc., Cambridge, MA, USA
| | - Lovisa Afzelius
- Inflammation and Immunology, Pfizer Inc., Cambridge, MA, USA
| | | | - Scott Jelinsky
- Inflammation and Immunology, Pfizer Inc., Cambridge, MA, USA
| | - Chao Tian
- 23andMe Research Team, 23andMe Inc., Sunnyvale, CA, USA
| | | | | | - Nan Bing
- Inflammation and Immunology, Pfizer Inc., Cambridge, MA, USA
| | - Kenneth Hung
- Inflammation and Immunology, Pfizer Inc., Cambridge, MA, USA
| | - Russ B Altman
- Department of Bioengineering, Stanford University, Shriram Room 209, MC: 4245, 443 Via Ortega Drive, Stanford, CA, 94305-4145, USA.
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Finn MTM, Brown HR, Friedman ER, Kelly AG, Hansen K. Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine. Glob Adv Health Med 2021; 10:2164956121997361. [PMID: 33680574 PMCID: PMC7900841 DOI: 10.1177/2164956121997361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/17/2021] [Accepted: 01/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Integrative medicine is a key framework for the treatment of chronic medical
conditions, particularly chronic pain conditions. The COVID-19 pandemic
prompted rapid implementation of telehealth services. Objective We present outcomes of a complete and rapid transition to telehealth visits
at an outpatient integrative medicine center in the Southeastern United
States. Method Patients and administrative staff took surveys comparing telehealth to
in-person visits within four weeks of our clinic's transition to telehealth
and three months later. Beginning four weeks after the clinic’s telehealth
conversion in March 2020, patients who had a telehealth visit at the center
completed a survey about their telehealth experience and another survey
three months later. Results Patient quality judgements significantly favored telehealth at baseline,
B = .77 [0.29 – 1.25], SE = .25, t(712) = 3.15, p = .002,
and increased at three months, B = .27 [–0.03 – 0.57], SE = .15,
t(712) = 1.76, p = .079. Telehealth technology
usability and distance from the center predicted patient ratings of
telehealth favorability. Providers favored in-person visits more than
patients, B = –1.00 [–1.56 – –0.44], SE = .29,
t(799) = –3.48, p < .001, though did not favor either
in-person or telehealth more than the other. Patient discrete choice between
telehealth and in-person visits was split at baseline (in-person: n = 86
[54%]; telehealth: n = 73 [46%]), but favored telehealth at three months
(in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete
choice favored telehealth at follow-up across providers and patients,
OR = 2.69 [.1.18 – 6.14], z = 2.36, p = .018. Major qualitative themes
highlight telehealth as acceptable and convenient, with some challenges
including technological issues. Some felt a loss of interpersonal connection
during telehealth visits, while others felt the opposite. Conclusion We report converging mixed-method data on the successful and sustained
implementation of telehealth with associated policy and clinical
implications during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Michael T M Finn
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Adult Congenital Heart Disease Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Hannah R Brown
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Emily R Friedman
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University School of Nursing, Nashville, Tennessee
| | - A Grace Kelly
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn Hansen
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Kim AH, Girgis A, De Cruz P, Siegel CA, Karimi N, Ruban SO, Sechi AJ, Ng WSW, Andrews JM, Connor SJ. Development and Feasibility of a Web-Based Decision Aid for Patients With Ulcerative Colitis: Qualitative Pilot Study. J Med Internet Res 2021; 23:e15946. [PMID: 33629956 PMCID: PMC7952232 DOI: 10.2196/15946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background Shared decision making (SDM) is becoming an important part of ulcerative colitis (UC) management because of the increasing complexity of available treatment choices and their trade-offs. The use of decision aids (DA) may be effective in increasing patients’ participation in UC management but their uptake has been limited due to high attrition rates and lack of a participatory approach to their design and implementation. Objective The primary aim of this study is to explore the perspectives of Australian patients and their clinicians regarding the feasibility and acceptability of myAID, a web-based DA, in informing treatment decisions in UC. The secondary aim is to use the findings of this pilot study to inform the design of a cluster randomized clinical trial (CRCT) to assess the efficacy of the DA compared with usual care. Methods myAID, a DA was designed and developed using a participatory approach by a multidisciplinary team of clinicians, patients, and nonmedical volunteers. A qualitative pilot study to evaluate the DA, involving patients with UC facing new treatment decisions and inflammatory bowel disease clinicians, was undertaken. Results A total of 11 patients with UC and 15 clinicians provided feedback on myAID. Themes explored included the following: Acceptability and usability of myAID—myAID was found to be acceptable by the majority of clinicians as a tool to facilitate SDM, uptake was thought to vary depending on clinicians’ approaches to patient education and practice, potential to overcome time restrictions associated with outpatient clinics was identified, presentation of unbiased information enabling patients to digest information at their own pace was noted, and potential to provoke anxiety among patients with a new diagnosis or mild disease was raised; Perceived role and usefulness of myAID—discordance was observed between patients who prioritized voicing preferences and clinicians who prioritized treatment adherence, and myAID facilitated early discussion of medical versus surgical treatment options; Target population and timing of use—greatest benefit was perceived at the time of initiating or changing treatment and following commencement of immunosuppressive therapy; and Potential concerns and areas for improvement—some perceived that use of myAID may precipitate anxiety by increasing decisional conflict and impact the therapeutic relationship between patient and the clinician and may increase resource requirements. Conclusions These preliminary findings suggest that patients and clinicians consider myAID as a feasible and acceptable tool to facilitate SDM for UC management. These pilot data have informed a participatory approach to the design of a CRCT, which will evaluate the clinical efficacy of myAID compared with usual care. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12617001246370; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617001246370.
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Affiliation(s)
- Andrew H Kim
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.,Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Peter De Cruz
- Department of Gastroenterology, The Austin Hospital, Melbourne, Australia.,Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Australia
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Neda Karimi
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Sasha O Ruban
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Alexandra J Sechi
- Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
| | - Wa Sang Watson Ng
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.,Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
| | - Jane M Andrews
- IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, Australia.,Faculty of Medicine, University of Adelaide, Adelaide, Australia
| | - Susan J Connor
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.,Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
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de Jong ME, Taal E, Thomas PWA, Römkens TEH, Jansen JM, West RL, Slotman E, Hoentjen F, Russel MGVM. Cross-cultural translation and validation of the IBD-control questionnaire in The Netherlands: a patient-reported outcome measure in inflammatory bowel disease. Scand J Gastroenterol 2021; 56:155-161. [PMID: 33300822 DOI: 10.1080/00365521.2020.1857430] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is a need for easy-to-use patient-reported outcome measures (PROMS) in inflammatory bowel disease (IBD) practice. The 'IBD-control' is a short IBD-specific questionnaire capturing disease control from the patient's perspective. The International Consortium for Health Outcomes Measurement (ICHOM) recommends the use of the IBD-control even though it has only been validated in the United Kingdom. We aimed to cross-culturally translate and validate the IBD-control in the Netherlands using IBDREAM, a prospective multicentre IBD registry. METHODS Lack of ambiguity and acceptability were verified in a pilot patient group (n = 5) after forward-backward translation of the IBD-control. Prospective validation involved completion of the IBD-control, Short Form-36, short IBDQ and disease activity measurement by Physician Global Assessment (PGA) and Simple Clinical Colitis Activity Index or Harvey-Bradshaw Index. Test-retest (2-week repeat) was used for measuring reliability. RESULTS Questionnaires were completed by 998 IBD patients (674 Crohn's disease, 324 ulcerative colitis). Internal consistency (Cronbach's alpha) was 0.82 for the sub-group of 8 questions (IBD-control-8-sub-score). Mean completion time was 105 s. Construct validity analyses demonstrated moderate-to-strong correlations of the IBD-control-8-subscore and the other instruments (0.49-0.81). Test-retest reliability for stable patients was high (intraclass correlation coefficient 0.95). The IBD-control-8-subscore showed good discriminant ability between the PGA categories (ANOVA, p<.001). Sensitivity to change analyses showed large effect sizes of 0.81-1.87 for the IBD-control-8 subscore. CONCLUSIONS These results support the IBD-control as a rapid, reliable, valid and sensitive instrument for measuring disease control from an IBD patient's perspective in the Netherlands.
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Affiliation(s)
- Michiel E de Jong
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Erik Taal
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Pepijn W A Thomas
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Rachel L West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Ellen Slotman
- Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maurice G V M Russel
- Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands
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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: 16] [Impact Index Per Article: 5.3] [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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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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Krishnaprasad K, Walsh A, Begun J, Bell S, Carter D, Grafton R, Sechi A, Sewell K, McMahon A, Connor S, Radford-Smith G, Andrews JM. Crohn's Colitis Care (CCCare): bespoke cloud-based clinical management software for inflammatory bowel disease. Scand J Gastroenterol 2020; 55:1419-1426. [PMID: 33161791 DOI: 10.1080/00365521.2020.1839960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adherence to evidence-based management is variable in inflammatory bowel disease (IBD), which leads to worse patient outcomes and higher healthcare utilization. Solutions include electronic systems to enhance care, but these have often been limited by lack of clinician design input, poor usability, and low perceived value. A cloud-based IBD-specific clinical management software - 'Crohn's Colitis Care' (CCCare) was developed by Australia and New Zealand Inflammatory Bowel Disease Consortium clinicians and software developers to improve this. METHODS CCCare captures patient-reported disease activity and medical assessment, medication monitoring, cancer screening, preventative health, and facilitates communication with the IBD team and referring doctor. De-identified longitudinal data are stored separately in a clinical quality registry for research. CCCare was tested for feasibility and usability in routine clinical settings at two large Australian hospitals. Users' experience was evaluated with System Usability Scale (SUS). Value to clinicians and patients was assessed by qualitative feedback. Security was assessed by penetration testing. RESULTS Users (n = 13; doctors, nurses, patients) reported good usability and learnability (mean SUS score 75 (range 50-95), sub-scores were 77 (50-94) and 68 (38-100), respectively). Patients reported better communication with clinical team and greater ability to track disease. Clinicians highlighted structured management plans, medication adherence, and centralised data repository as positive features. Penetration testing was passed successfully. CONCLUSIONS Initial evaluation demonstrates CCCare is usable, secure, and valued in clinical use. It is designed to measure outcomes of clinical care, including efficacy, quality, cost, and complications for individuals, and to audit these at hospital and national level.
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Affiliation(s)
- Krupa Krishnaprasad
- Gut Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Alissa Walsh
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Jakob Begun
- Department of Gastroenterology, Mater Hospital, Brisbane, Australia
| | - Sally Bell
- Department of Gastroenterology, Monash Health, Melbourne, Australia
| | - David Carter
- Stratos Technology Partners, Christchurch, New Zealand
| | - Rachel Grafton
- Department of Gastroenterology, Royal Adelaide Hospital & University of Adelaide, Adelaide, Australia
| | - Alexandra Sechi
- Department of Gastroenterology, Liverpool Hospital, University of NSW & Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Karen Sewell
- Department of Gastroenterology, Mater Hospital, Brisbane, Australia
| | - Anna McMahon
- Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Susan Connor
- Department of Gastroenterology, Liverpool Hospital, University of NSW & Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Graham Radford-Smith
- Gut Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,University of Queensland School of Medicine, Brisbane, Australia
| | - Jane M Andrews
- Department of Gastroenterology, Royal Adelaide Hospital & University of Adelaide, Adelaide, Australia
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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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44
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Suriani R, Ercole E, Niola P, Astegiano M, Sambataro A, Ravizza M. IBD passport: A novel educational model in IBD patients. Dig Liver Dis 2020; 52:1067-1068. [PMID: 32522432 DOI: 10.1016/j.dld.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Renzo Suriani
- Scientific Director A.M.I.C.I. Piemonte, Turin Italy
| | - Elena Ercole
- Gastroenterology Unit Ospedalethat Mauriziano, Turin, Italy
| | - Paolo Niola
- Gastroenterology Unit Cardinal Massaia Hospital Asti, Italy
| | - Marco Astegiano
- Gastroenterology Academic Gasrtroenterology Unit Health and Science City, Turin, Italy
| | - Angela Sambataro
- Gastroenterology Unit San Luigi Gonzaga Academic Hospital, Orbassano, Italy
| | - Mauro Ravizza
- formerly Gastroenterology Unit ASL Città di Torino, Turin, Italy.
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Eze ND, Mateus C, Cravo Oliveira Hashiguchi T. Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS One 2020; 15:e0237585. [PMID: 32790752 PMCID: PMC7425977 DOI: 10.1371/journal.pone.0237585] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation. Methods This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool. Results Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings. Conclusion This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.
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Affiliation(s)
- Nkiruka D Eze
- Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom
| | - Céu Mateus
- Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom
| | - Tiago Cravo Oliveira Hashiguchi
- Health Division Organisation for Economic Co-operation and Development, Directorate for Employment, Labour and Social Affairs, Paris, France
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Kim AH, Girgis A, Karimi N, Sechi AJ, Descallar J, Andrews JM, Siegel CA, Connor SJ. A Web-Based Decision Aid (myAID) to Enhance Quality of Life, Empowerment, Decision Making, and Disease Control for Patients With Ulcerative Colitis: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15994. [PMID: 32673257 PMCID: PMC7382012 DOI: 10.2196/15994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients with ulcerative colitis (UC) often face complex treatment decisions. Although shared decision making (SDM) is considered important, tools to facilitate this are currently lacking for UC. A recent pilot study of a novel Web-based decision aid (DA), my Actively Informed Decision (myAID), has suggested its acceptability and feasibility for informing treatment decisions and facilitating SDM in clinical practice. OBJECTIVE This paper describes the study protocol of the myAID study to assess the clinical impact of systematic implementation of myAID in routine UC management. METHODS The myAID study is a multicenter, cluster randomized controlled trial (CRCT) involving 22 Australian sites that will assess the clinical efficacy of routine use of myAID (intervention) against usual care without access to myAID (control) for UC patients. Participating sites (clusters) will be randomly allocated in a 1:1 ratio between the 2 arms. Patients making a new treatment decision beyond 5-aminosalicylate agents will be eligible to participate. Patients allocated to the intervention arm will view myAID at the time of recruitment and have free access to it throughout the study period. The effect of the myAID intervention will be assessed using the results of serial Web-based questionnaires and fecal calprotectin at baseline, 2 months, 6 months, and 12 months. A Web-based questionnaire within 2-4 weeks of referral will determine early change in quality of decision making and anxiety (both arms) and intervention acceptability (intervention arm only). RESULTS Study recruitment and funding began in October 2016, and recruitment will continue through 2020, for a minimum of 300 study participants at baseline at the current projection. The primary outcome will be health-related quality of life (Assessment of Quality of Life-8D), and secondary outcomes will include patient empowerment, quality of decision making, anxiety, work productivity and activity impairment, and disease activity. In addition, we aim to determine the predictors of UC treatment decisions and outcomes and the cost-effectiveness of implementing myAID in routine practice. Feedback obtained about myAID will be used to determine areas for improvement and barriers to its implementation. Completion of data collection and publication of study results are anticipated in 2021. CONCLUSIONS myAID is a novel Web-based DA designed to facilitate SDM in UC management. The results of this CRCT will contribute new evidence to the literature in comparing outcomes between patients who routinely access such decision support intervention versus those who do not, across multiple large inflammatory bowel disease centers as well as community-based private practices in Australia. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12617001246370 http://anzctr.org.au/Trial/ Registration/TrialReview.aspx?ACTRN=12617001246370. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15994.
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Affiliation(s)
- Andrew H Kim
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia.,Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Neda Karimi
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Alexandra J Sechi
- Department of Gastroenterology, Liverpool Hospital, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Jane M Andrews
- IBD Service, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, Australia.,Faculty of Medicine, University of Adelaide, Adelaide, Australia
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Susan J Connor
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
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Zand A, Nguyen A, Stokes Z, van Deen W, Lightner A, Platt A, Jacobs R, Reardon S, Kane E, Sack J, Hommes D. Patient Experiences and Outcomes of a Telehealth Clinical Care Pathway for Postoperative Inflammatory Bowel Disease Patients. Telemed J E Health 2020; 26:889-897. [DOI: 10.1089/tmj.2019.0102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Aria Zand
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Leiden University Medical Center, Department of Digestive Diseases, Leiden, The Netherlands
| | - Audrey Nguyen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Zack Stokes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Welmoed van Deen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amy Lightner
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anya Platt
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Rutger Jacobs
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Sarah Reardon
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
| | - Ellen Kane
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Jonathan Sack
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
| | - Daniel Hommes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Leiden University Medical Center, Department of Digestive Diseases, Leiden, The Netherlands
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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: 0.8] [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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49
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Pellino G, Keller DS, Sampietro GM, Annese V, Carvello M, Celentano V, Coco C, Colombo F, Cracco N, Di Candido F, Franceschi M, Laureti S, Mattioli G, Pio L, Sciaudone G, Sica G, Villanacci V, Zinicola R, Leone S, Danese S, Spinelli A, Delaini G, Selvaggi F. Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management. Tech Coloproctol 2020; 24:105-126. [PMID: 31983044 DOI: 10.1007/s10151-019-02145-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 02/08/2023]
Abstract
The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a Position Statement of Italian colorectal surgeons to address the surgical aspects of inflammatory bowel disease management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the general principles of surgical treatment of inflammatory bowel disease. The committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.
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Affiliation(s)
- G Pellino
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy.
| | - D S Keller
- Division of Colon and Rectal Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Medical Center, New York, USA
| | | | - V Annese
- Gastroenterology Unit, DEA-Medicina E Chirurgia Generale E D'Urgenza, University Hospital Careggi, Firenze, Italy
| | - M Carvello
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - V Celentano
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
- University of Portsmouth, Portsmouth, UK
| | - C Coco
- UOC Chirurgia Generale 2, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - F Colombo
- L. Sacco University Hospital Milano, Milan, Italy
| | - N Cracco
- Department of General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - F Di Candido
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Franceschi
- IBD Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Laureti
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Mattioli
- Pediatric Surgery Unit, Istituto Giannina Gaslini, and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - L Pio
- Pediatric Surgery Department, Hôpital Robert-Debré and Université de Paris, Paris, France
| | - G Sciaudone
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy
| | - G Sica
- Minimally Invasive and Gastro-Intestinal Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - V Villanacci
- Institute of Pathology, Spedali Civili Brescia, Brescia, Italy
| | - R Zinicola
- Department of Emergency Surgery, University Hospital Parma, Parma, Italy
| | - S Leone
- CEO, Associazione Nazionale Per Le Malattie Infiammatorie Croniche Dell'Intestino "A.M.I.C.I. Onlus", Milan, Italy
| | - S Danese
- Division of Gastroenterology, IBD Center, Humanitas University, Rozzano, Milan, Italy
| | - A Spinelli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - G Delaini
- Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy
| | - F Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy
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50
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Pouillon L, Hoefkens E, Verheyen V, Bronswijk M, Van Olmen A, Van Dessel S, Siborgs N, Bossuyt P. Letter to the Editor: Feasibility and Efficiency of an E-Health Preadmission Assessment System for Intravenous Therapy in Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:e11-e12. [PMID: 31793628 DOI: 10.1093/ibd/izz304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lieven Pouillon
- Imelda GI Clinical Research Centre, Imelda General Hospital, Bonheiden, Belgium
| | - Eveline Hoefkens
- Imelda GI Clinical Research Centre, Imelda General Hospital, Bonheiden, Belgium
| | | | - Michiel Bronswijk
- Imelda GI Clinical Research Centre, Imelda General Hospital, Bonheiden, Belgium
| | - August Van Olmen
- Imelda GI Clinical Research Centre, Imelda General Hospital, Bonheiden, Belgium
| | | | - Nancy Siborgs
- IT Department, Imelda General Hospital, Bonheiden, Belgium
| | - Peter Bossuyt
- Imelda GI Clinical Research Centre, Imelda General Hospital, Bonheiden, Belgium
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