Telemedicine and Mobile Health Technology Are Effective in the Management of Digestive Diseases: A Systematic Review

Experiences of Irritable Bowel Syndrome Patients in a Virtual Yoga Program: Qualitative Findings from a Clinical Trial

BACKGROUND AND AIMS

In-person yoga interventions have shown feasibility and effectiveness in improving the outcomes of patients with irritable bowel syndrome (IBS), but experiences in virtual yoga interventions have not been examined. This study aimed to explore patients' experiences of a virtually delivered yoga intervention for IBS.

METHODS

An embedded qualitative substudy was included in a randomized controlled trial examining the feasibility and effectiveness of a virtual yoga program among adult patients with IBS. Semi-structured interviews captured participants' past and current experiences, program satisfaction, perceived impact on IBS symptoms and overall physical and mental health, facilitators and barriers to participation, perceptions of social support and supervised learning, and input on improving future programming. Data were coded and analyzed in duplicate using NVivo 12. An analytic template based on the interview guide was developed and thematic analysis identified themes, as well as the relationship between themes and subthemes.

RESULTS

Among the 14 participants (all female, mean age 47.7 years), three major themes were identified: (1) positive experience in the yoga program, (2) incorporating yoga into IBS management post-study, and (3) recommendations for program improvement.

CONCLUSION

Patients with IBS experience in a virtual yoga program was positive with improvements in physical and mental health outcomes. Considering the barriers and facilitators to participating in an online yoga program along with participant recommendations may improve future intervention design and delivery to increase self-efficacy and confidence among patients with IBS.

Application of telemedicine system on the management of general patient in quarantine

To limit the epidemic of COVID-19, most countries and regions have adopted the policy of quarantine, providing an opportunity for the development of telemedicine. This study aims to develop a telemedicine system within a quarantined district and validate its effectiveness and safety in managing a variety of diseases within the population. Appling the private network and specialized set, telemedicine system and service process were constructed in the quarantine district. Based on the patients' conditions, the staffs supplied kinds of medical service for the patients in the quarantine district. The basic characteristics and results of patients in the quarantine area who used telemedicine system during January to September 2022 were statistically analyzed. Within this period, 2410 cases were included in this study, among which, 1803 patients directly saw a doctor by the Internet hospital in the Internet hospital of telemedicine system, 607 patients used telemedicine system, 166 patients achieved referral to a specific hospital via telemedicine system, and 162 cases made further consultation, with no infection cases in the quarantine zone and no death cases. The six most occurred diseases were respiratory disease (20.6%), ophthalmology and otorhinolaryngology (12.9%), cardiovascular diseases (12.7%), digestive system disease (12.5%), dermatological diseases (10.6%), and metabolic and endocrine diseases (7.6%). The top three referred cases were obstetric diseases (19.3%), others (12.0%) and respiratory disease (10.2%). There were statistically significant differences between the diseases of the cases using telemedicine system with and without referral (P < 0.001). It is feasible, effective and efficient to construct and use telemedicine system in quarantine area. It is an approach to manage many patients by indirectly contact. With the solution of follow-up related problems and the application of novel technologies, telemedicine may usher in greater development.

Are we ready for telemonitoring inflammatory bowel disease? A review of advances, enablers, and barriers

This review summarizes the evidence about telemonitoring in patients with inflammatory bowel disease (IBD). To give an overview of the advances performed, as well as the enablers and barriers which favoured/hindered telemonitoring implementation. We performed a literature search in PubMed, EMBASE, MEDLINE, Cochrane Database, Web of Science and Conference Proceedings. Titles and abstracts published up to September 2022 were screened for a set of inclusion criteria: telemonitoring intervention, IBD as the main disease, and a primary study performed. Ninety-seven reports were selected for full review. Finally, 20 were included for data extraction and critical appraisal. Most studies used telemonitoring combined with tele-education, and programs evolved from home telemanagement systems towards web portals through mHealth applications. Web systems demonstrated patients’ acceptance, improvement in quality of life, disease activity and knowledge, with a good cost-effectiveness profile in the short-term. Initially, telemonitoring was almost restricted to ulcerative colitis, but new patient reported outcome measures, home-based tests and mobile devices favoured its expansion to different patients´ categories. However, technological and knowledge advances led to legal, ethical, economical and logistic issues. Standardization of remote healthcare is necessary, to improve the interoperability of systems as well as to address liability concerns and users´ preferences. Telemonitoring IBD is well accepted and improves clinical outcomes at a lower cost in the short-term. Funders, policymakers, providers, and patients need to align their interests to overcome the emerging barriers for its full implementation.

Evaluation of the Effectiveness of Telemedicine Visits in a Pediatric Gastroenterology Service in the Context of COVID-19

BACKGROUND

During the first months of COVID-19, the Gastroenterology, Hepatology and Nutrition service of the Hospital Sant Joan de Déu in Barcelona, a leading pediatric center in Spain, introduced a new model of non-face-to-face care.

OBJECTIVE

To evaluate the impact of telephone consultations compared to those conducted face-to-face on healthcare utilization.

METHODOLOGY

Two main indicators of effectiveness are used: the degree of resolution (percentage of first telemedicine visits that did not generate any new visits in the following 4 and 12 months) and the average number of subsequent visits. A distinction was made between visits for general pathologies (less complex) and those for pathologies treated in monographic consultations (chronic or complex pathologies). Effectiveness at 4 and 12 months was also compared.

RESULTS

After 4 months from the first visit, the degree of resolution is lower in the first telemedicine visits than in face-to-face visits for both general pathologies and those of monographic agendas for chronic and complex pathologies. After twelve months, the first general telemedicine visits are less resolute than face-to-face visits, while the resolution rate is the same for chronic and complex pathology visits. Each telemedicine visit generates on average more visits than face-to-face visits. In the short term, 133.4% more in the case of general visits and 51.4% more in the case of chronic and complex visits. In the long term, general telemedicine visits generate 57.31% more visits, while no statistically significant difference is observed between chronic and complex face-to-face and telemedicine visits.

CONCLUSION

The results of this study show that the resolution capacity of the non-face-to-face model in pediatric care in the pandemic context is generally lower and generates more successive visits than the face-to-face model. This lower performance of the telemedicine model should be counterbalanced with its advantages.

Telemedicina: validación de un cuestionario para evaluar la experiencia de los profesionales de la salud

Objetivo.

El siguiente trabajo tiene como objetivo desarrollar y validar un cuestionario para evaluar la experiencia de los profesionales de la salud con los sistemas de telemedicina.

Métodos.

A partir de la versión abreviada en español y validada localmente del cuestionario para pacientes desarrollado por Parmanto y col., un grupo de expertos consensuó una versión para evaluar la experiencia de profesionales de la salud que brindan servicios de telemedicina. El comportamiento psicométrico de los ítems se testeó en una primera muestra de 129 profesionales a través de un análisis factorial exploratorio. Luego, se evaluó su comprensibilidad a través de entrevistas cognitivas. Por último, en una nueva muestra de 329 profesionales, se evaluó la validez de constructo del cuestionario mediante un análisis factorial confirmatorio (AFC), y su validez de criterio externo, mediante la evaluación de su puntaje con el de una pregunta de resumen.

Resultados.

Se obtuvo un cuestionario de 12 ítems con una estructura de dos factores con indicadores de ajuste aceptables, documentada mediante AFC. La fiabilidad, la validez convergente y la validez discriminante fueron apropiadas. La validez de criterio externo mostró resultados óptimos.

Conclusiones.

El instrumento obtenido cuenta con propiedades psicométricas adecuadas y contribuirá a la evaluación objetiva de la experiencia de los profesionales que realizan telemedicina.

Mobile Apps for the Management of Gastrointestinal Diseases: Systematic Search and Evaluation Within App Stores

Background

Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear.

Objective

This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases.

Methods

A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality.

Results

The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05).

Conclusions

Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps.

Utilization and Effectiveness of eHealth Technology in the Follow-up of Celiac Disease: A Systematic Review

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.

Meditation and yoga for irritable bowel syndrome: study protocol for a randomised clinical trial (MY-IBS study)

INTRODUCTION

When delivered in person, yoga has been shown to be effective in managing irritable bowel syndrome (IBS) symptoms. Research is needed to test the feasibility and effectiveness of yoga as a therapeutic option when delivered virtually. The primary aim of the mind and yoga for IBS randomised controlled trial is to determine the effects of an 8-week virtual meditation and yoga intervention on IBS symptom severity compared with an advice-only active control group.

METHODS AND ANALYSIS

Adults diagnosed with IBS will be randomised to receive either a Upa Yoga intervention or an advice-only control group. The intervention will consist of weekly online classes for 8 weeks delivered by a facilitator using Microsoft Office Teams and daily home practice. Feasibility will be evaluated by examining recruitment and attrition rates, adherence, participant satisfaction with the programme and safety. The primary outcome is IBS symptom severity, and key secondary outcomes include (but not limited to) quality of life, anxiety and depression symptoms, COVID-19-related stress and anxiety, and fatigue. Outcomes will be assessed at baseline, 4 weeks and 8 weeks. An embedded design experimental model substudy will be conducted post intervention using qualitative research methods to identify participants' experiences in the yoga programme.

ETHICS AND DISSEMINATION

This study has been approved by the Conjoint Health Research Ethics Board (REB ID 20-0084). Findings will be disseminated through peer-reviewed publication, conference presentation and social media.

TRIAL REGISTRATION NUMBER

NCT04302623.

A new Digital Health Program for Patients with Inflammatory Bowel Disease: Preliminary Program Evaluation (Preprint)

BACKGROUND

Inflammatory bowel disease (IBD) causes chronic inflammation of the gastrointestinal tract. IBD is characterized by an unpredictable disease course that varies greatly between individuals and alternates between the periods of relapse and remission. A low energy level (fatigue) is a common symptom, whereas stress and reduced sleep quality may be the triggering factors. Therapeutic guidelines call for effective disease assessment, early intervention, and personalized care using a treat-to-target approach, which may be difficult to achieve through typical time- and resource-constrained standard care. Providing patients with a digital health program that incorporates helpful self-management features and patient support to complement standard care may be optimal for improving the disease course.

OBJECTIVE

This study aimed to perform a preliminary program evaluation, analyzing engagement and preliminary effectiveness and the effect on participants' energy levels (fatigue), stress, and sleep quality, of a newly developed 16-week digital health program (SK-311 and SK-321) for patients with IBD.

METHODS

Adults with IBD were recruited to participate in a real-world, live, digital health program via Finnish IBD patient association websites and social media. No inclusion or exclusion criteria were applied for this study. Baseline characteristics were entered by the participants upon sign-up. Platform engagement was measured by tracking the participants' event logs. The outcome measures of stress, energy levels (fatigue), and quality of sleep were reported by participants through the platform.

RESULTS

Of the 444 adults who registered for the digital health program, 205 (46.2%) were included in the intention-to-treat sample. The intention-to-treat participants logged events on average 41 times per week (5.9 times per day) during the weeks in which they were active on the digital platform. More women than men participated in the intervention (126/205, 88.7%). The mean age of the participants was 40.3 (SD 11.5) years, and their mean BMI was 27.9 (SD 6.0) kg/m². In total, 80 people provided the required outcome measures during weeks 12 to 16 (completers). Treatment completion was strongly predicted by the number of active days in week 1. Analysis of the completers (80/205, 39%) showed significant improvements for stress (t₇₉=4.57; P<.001; percentage change=-23.26%) and energy levels (t₇₉=-2.44; P=.017; percentage change=9.48%); however, no significant improvements were observed for quality of sleep (t₇₉=-1.32; P=.19).

CONCLUSIONS

These results support the feasibility of a digital health program for patients with IBD (SK-311 and SK-321) and suggest that treatment completion might have a substantial positive effect on patient-reported stress and energy levels in a real-world setting. These findings are promising and provide initial support for using the Sidekick Health digital health program to supplement standard care for patients with IBD.

No pelvic exam, no problem: patient satisfaction following the integration of comprehensive urogynecology telemedicine

Introduction and hypothesis

The COVID-19 pandemic revolutionized the practice of medicine, requiring rapid adoption of telemedicine. However, patient satisfaction has not been well characterized for telemedicine visits for a broad range of urogynecologic conditions.

Methods

We performed a cross-sectional survey study following a retrospective review of all urogynecologic telemedicine visits from March 1, 2020, to March 31, 2021, at a tertiary care center. The survey queried patient satisfaction using the Likert scale. Descriptive statistics and Fisher’s exact analyses were performed.

Results

There were 256 telemedicine visits at our institution during the study period, and 88 patients (34% unadjusted response rate) completed the survey. The average age of study participants was 55 (SD 17; 24, 84) years old. The majority of patients were white (69%), lived within the five boroughs of NYC (81%), and had higher levels of education (72% with a bachelor’s or professional degree). Most visits were for urinary complaints (68%), with those patients reporting greater fulfillment of urogynecologic needs compared to patients presenting with pelvic complaints (p = 0.02). There were no significant differences in satisfaction among other demographics (p > 0.05). Altogether, high satisfaction rates were noted for scheduling (99%), technology (90%), provider interaction (96%), fulfillment of personal needs (91%), and overall satisfaction (94%).

Conclusions

We demonstrate high patient satisfaction for telemedicine visits in a tertiary urogynecology clinic for a variety of indications, with greater fulfillment of urogynecologic needs observed for those visits which may not necessitate an in-person exam (e.g., urinary complaint).

Digital Technology in Visceral Medicine: An Overview in Outpatient Care in Germany

Background

Digital technology has become an integral part of healthcare and will revolutionize the practice of medicine. Although previously the administrative tasks were captured by digital technologies, now the communication channels with the patients are also being focused. For example, taking medical histories is now made possible by this new technology, information and explanatory forms can be sent digitally, and even face-to-face consultations are increasingly made possible by video consultations. Especially in the COVID pandemic, this form of contactless encounter has become a valuable enrichment of medical care. But also telemedical tasks such as teleconsultation or artificial intelligence in the context of adenoma detection are techniques that are conquering outpatient and inpatient visceral medical care.

Summary

This article gives an overview of digital communication and possible uses of digital technologies in medical practices in Germany.

Key Message

Medicine is renewing itself through digital techniques. The pace of change is rapid and unstoppable. Today's medical progress is no longer conceivable without these techniques.

Evaluating barriers to and promoters of telehealth during the COVID-19 pandemic at U.S. cystic fibrosis programs

BACKGROUND

Cystic fibrosis (CF) care programs in the United States rapidly adopted telehealth during the COVID-19 pandemic. Understanding factors that promote or impede telehealth will inform planning for future telehealth-enabled care models.

METHODS

Adult, pediatric, and affiliate CF care programs in the United States (n = 287) were surveyed twice eight months apart in 2020-2021 about telehealth use. Programs were asked to describe barriers to and promoters of telehealth.

RESULTS

Ninety-seven percent of programs provided telehealth services. In the first CF Care Program State of Care Survey (SoC1), programs estimated that 57% of patients exclusively received in-person care, 36% of patients received telehealth by phone/computer with video, and 8% of patients received telephone-only care. In the second CF Care Program State of Care Survey (SoC2), programs estimated that 80% of visits were in-person and 15% were via audio and video telehealth. Pediatric programs (21%) were less likely than adult (37%) or affiliate (41%) programs to recommend telehealth (p = 0.007). All programs ranked lack of internet access as the highest barrier to patient engagement with telehealth. Promoters of telehealth were increased accessibility and avoidance of infection transmission. Top ranked changes to improve telehealth were expanded provision of remote monitoring devices and technology access. Similar proportions of program types anticipated institutional telehealth expansion.

CONCLUSION

During the COVID-19 pandemic, CF programs in the United States identified factors to improve future care delivery via telehealth. Targeting specific barriers and promoters will improve the use and quality of telehealth throughout the care center network.

Web-Based and mHealth Interventions for Intimate Partner Violence Victimization Prevention: A Systematic Review

Mobile health (mHealth) technologies are increasingly used across health programming including intimate partner violence (IPV) prevention to optimize screening, educational outreach, and linkages to care via telehealth. We systematically evaluated current web-based and mHealth interventions, which include web- or mobile-based delivery methods for primary, secondary, and tertiary IPV victimization prevention. We searched MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Open Grey, and Google Scholar for empirical studies published 1998-2019. Studies were included if they considered empirical data, participants in adult romantic relationships, IPV as a primary or secondary outcome, and an mHealth component. The Mixed Methods Appraisal Tool was used to record critical ratings of quality among studies selected for inclusion. We assessed variation in targeted populations, types of IPV addressed, and mHealth approaches used. Of 133 studies identified for full-text review, 31 were included. Computer-based screening with or without integrated education was the most common mHealth approach (n = 8, 26%), followed by safety decision aids (n = 7, 23%). Feasibility and acceptability were found to be generally high where assessed (23% of studies, n = 7). There was limited evidence around whether mHealth interventions better addressed population needs compared to conventional interventions. mHealth tools for IPV prevention are especially acceptable in health-care settings, on mobile phone platforms, or when connecting victims to health care. Despite enthusiasm in pilot projects, evidence for efficacy compared to conventional IPV prevention approaches is limited. A major strength of mHealth IPV prevention programming is the ability to tailor interventions to individual victim needs without extensive human resource expenditure by providers.

Changes in the management of IBD patients since the onset of COVID-19 pandemic. A path toward the implementation of telemedicine in Spain?

Background

COVID-19 pandemic increased medical services demand aside from interrupting daily clinical practice for other diseases such as inflammatory bowel disease (IBD). Here we present the results of a survey to gain the perception of IBD specialists in their patient-management using telemedicine in their daily practice.

Methods

This was an observational survey study among physicians focused on IBD (gastroenterologist, surgeons, and pediatricians) members of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU), the Spanish Association of Gastroenterology (AEG), and the Spanish Association of Coloproctology (AECP), regarding changes of management of IBD patients.

Results

We received a total of 269 responses to the survey (from May to June 2020). Before the pandemic, nearly all the respondents reported performing very frequently their visits face-to-face (n = 251, 93.3%) while, during the pandemic, the telephone visits were the most frequent visits performed (n = 138, 51.3%). Regarding communication difficulties, 157 (58.4%) respondents reported the impossibility of performing a proper examination as the most relevant issue. Also, 114 (42.4%) respondents considered remote visits more time-consuming than face-to-face visits. Most gastroenterologists (n = 188, 83.2%) considered patients with active perianal disease in special need of face-to-face consultation and more than half of the surgeons (n = 35, 50.7%) reported having performed an immediate postoperative follow-up remotely.

Conclusions

Most IBD units have implemented remote visits during the pandemic, but most professionals found them more time-consuming and unsuitable for some disease profiles. Therefore, there is a need for the development of better telemedicine systems that can meet professionals’ and patients’ requirements.

Perceptions of Telehealth Among Commercial Members Who Responded to a Patient-Experience Survey During the Onset of the Coronavirus-19 Pandemic

Introduction: The body of literature on telehealth perception among commercial members is limited. Therefore, we administered a patient-experienced survey (Clinician and Group Consumer Assessment of Healthcare Providers and Systems [CG-CAHPS]) to determine member perceptions of telehealth, including willingness to pay for it and the likelihood to access it again. Methods: This study used a cross-sectional design, and members were assigned into two groups: those who had a telehealth visit with their primary care provider (PCP) or a provider in the same practice and those who had a telehealth visit with a provider outside of their PCP's practice. Logistic regression models were used to observe group differences in telehealth perception. Results: A total of 444 members replied to the CG-CAHPS survey and had a virtual visit; 21.1% had a telehealth visit with a provider outside of their PCP's practice, and 78.8% had a telehealth visit with their PCP or a provider in the same practice. Compared with members who saw a provider outside of their PCP's practice, members who saw their PCP or a provider in the same practice had 3.76 higher odds (confidence interval [95% CI]: 1.49-9.44) of rating in-person care as no different than virtual care; 2.29 higher odds (95% CI: 1.30-4.04) of reporting they would likely use telehealth again in the future; and 1.70 higher odds (95% CI: 0.99-2.91) of responding that they would be willing to pay an in-office visit copay for a telehealth visit. Conclusion: These results suggest that the familiarity of a member's PCP extends to the provider's practice and impacts member outlook on telehealth.

Impact of Digital Health Monitoring in the Management of Inflammatory Bowel Disease

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.

Consensus document on the management preferences of patients with ulcerative colitis: points to consider and recommendations

BACKGROUND AND AIMS

Our objective was to define, describe and organize (on the basis of consensus) the patient's preferences in the management of ulcerative colitis (UC), in order to further incorporate them in daily practice and improve patients satisfaction, adherence to the treatment and quality of care.

METHODS

Qualitative study. A narrative literature review in Medline using Mesh and free-text terms was conducted to identify articles on UC patient preferences as well as clinical scenarios that may influence the preferences. The results were presented and discussed in a multidisciplinary nominal group meeting composed of six gastroenterologists, one primary care physician, one nurse practitioner and one expert patient. Key clinical scenarios and patient preferences were then defined, generating a series of points to consider and recommendations. The level of agreement with the final selection of preferences was established following a Delphi process.

RESULTS

The narrative review retrieved 69 articles of qualitative design and moderate quality. The following key clinical scenarios were identified: diagnosis, follow-up, surgery, and special situations/patients profiles such as adolescents or women. Patient preferences were classified into information, treatment (pharmacological and non-pharmacological), follow-up, relations with health professionals, relations with the health system and administration. Finally, 11 recommendations on patient preferences for UC in relation to its management reached the level of agreement established.

CONCLUSION

The consensual description of patient's preferences contribute to identify different areas for improvement in healthcare practice.

A model for the pandemic and beyond: Telemedicine for all outpatient gastroenterology referrals reduces unnecessary clinic visits

The ongoing coronavirus disease 2019 pandemic has forced providers to dramatically scale down in-person clinic visits to enforce social distancing and triage care to the neediest patients. We describe our five-month experience with a hybrid gastroenterology electronic consultation programme starting in 2019 in which we perform electronic consultations for every referral regardless of indication as well as directly initiate telephone-based telehealth visits with patients without the need for in-person clinic. Over five consecutive months, 1243 hybrid electronic consultations were performed with 356 (29%) resulting in a clinic appointment. The remaining 887 (71%) electronic consultations were resolved without need for a clinic visit. Five hundred and fourteen (41%) electronic consultations resulted in a directly scheduled procedure without clinic appointment. Eighty-five per cent of electronic consultations were performed on the same day of referral and 98% of electronic consultations were completed in under 20 min. A hybrid electronic consultation model which pre-emptively reviews all outpatient referrals streamlines access to specialty care. Such a model may be implemented rapidly during the current coronavirus disease 2019 pandemic as well as serve as a platform for long-term improvement in efficiency of care.

Impact of mobile health and medical applications on clinical practice in gastroenterology

Mobile health apps (MHAs) and medical apps (MAs) are becoming increasingly popular as digital interventions in a wide range of health-related applications in almost all sectors of healthcare. The surge in demand for digital medical solutions has been accelerated by the need for new diagnostic and therapeutic methods in the current coronavirus disease 2019 pandemic. This also applies to clinical practice in gastroenterology, which has, in many respects, undergone a recent digital transformation with numerous consequences that will impact patients and health care professionals in the near future. MHAs and MAs are considered to have great potential, especially for chronic diseases, as they can support the self-management of patients in many ways. Despite the great potential associated with the application of MHAs and MAs in gastroenterology and health care in general, there are numerous challenges to be met in the future, including both the ethical and legal aspects of applying this technology. The aim of this article is to provide an overview of the current status of MHA and MA use in the field of gastroenterology, describe the future perspectives in this field and point out some of the challenges that need to be addressed.

Technology Acceptance in Mobile Health: Scoping Review of Definitions, Models, and Measurement

BACKGROUND

Designing technologies that users will be interested in, start using, and keep using has long been a challenge. In the health domain, the question of technology acceptance is even more important, as the possible intrusiveness of technologies could lead to patients refusing to even try them. Developers and researchers must address this question not only in the design and evaluation of new health care technologies but also across the different stages of the user's journey. Although a range of definitions for these stages exists, many researchers conflate related terms, and the field would benefit from a coherent set of definitions and associated measurement approaches.

OBJECTIVE

This review aims to explore how technology acceptance is interpreted and measured in mobile health (mHealth) literature. We seek to compare the treatment of acceptance in mHealth research with existing definitions and models, identify potential gaps, and contribute to the clarification of the process of technology acceptance.

METHODS

We searched the PubMed database for publications indexed under the Medical Subject Headings terms "Patient Acceptance of Health Care" and "Mobile Applications." We included publications that (1) contained at least one of the terms "acceptability," "acceptance," "adoption," "accept," or "adopt"; and (2) defined the term. The final corpus included 68 relevant studies.

RESULTS

Several interpretations are associated with technology acceptance, few consistent with existing definitions. Although the literature has influenced the interpretation of the concept, usage is not homogeneous, and models are not adapted to populations with particular needs. The prevalence of measurement by custom surveys suggests a lack of standardized measurement tools.

CONCLUSIONS

Definitions from the literature were published separately, which may contribute to inconsistent usage. A definition framework would bring coherence to the reporting of results, facilitating the replication and comparison of studies. We propose the Technology Acceptance Lifecycle, consolidating existing definitions, articulating the different stages of technology acceptance, and providing an explicit terminology. Our findings illustrate the need for a common definition and measurement framework and the importance of viewing technology acceptance as a staged process, with adapted measurement methods for each stage.

On the brighter side of COVID-19 induced Lockdown: Devising the collateral methods to provide Ayurveda consultation during impasse

COVID-19 pandemic and subsequent measures to mitigate it have presented the world with certain unprecedented situations. Lockdown with effective closure of all services including routine health care services has tested the nerves of health care providers for finding novel ways of providing services without getting into the risk of exposure. Telemedicine had been an ideal option for such situations allowing all channels of communication that leverage Information Technology platforms, including voice, audio, text and digital data exchange as a help to diagnosis, prescription and follow up evaluation. Unfortunately this versatility of Telemedicine as a patient –physician interface could not be harnessed well for its technical complexities and unpreparedness of institutions and individuals. Smartphone based video calling using whatsapp messenger has been proposed as a feasible Telemedicine application to provide outpatient services in this scenario. A pilot run of outpatient services during lockdown period through whatsapp facilitated video calling at Ayurveda Gathiya Clinic, State Ayurvedic College and Hospital, Lucknow has shown a way forward of running such services with a mass appeal, ease of operation and high interface gratification among users and service providers. Within its limitations related to the quality and quantity of information sought, this comes as a viable method of patient –physician interfacing during the phase of lockdown.

Lack of Telemedicine Training in Academic Medicine: Are We Preparing the Next Generation?

Background: Telemedicine focuses on providing medical care to patients in remote locations using telecommunication technologies. It has been shown to be cost-effective, improve health outcomes, and enhance patient satisfaction. This study examines the extent to which medical students and resident physicians are exposed to telemedicine during training. Materials and Methods: The authors accessed the American College of Graduate Medical Education (ACGME) Residency Milestones from specialties and subspecialties mentioned in the 2018 Milestones National Report and searched for key terms, including "Technology," "Telemedicine," "Telehealth," "EMR," "Electronic Medical Record," "EHR," "Electronic Health Record," "Electronics," and "Social Media." The authors also accessed the 2018 American Association of Medical Colleges (AAMC) "Curriculum Inventory and Reports" to retrieve data from surveys of medical schools that included telemedicine in required courses and electives for medical students from 2013 to 2018. Results: From the 104 ACGME specialty milestones, only one specialty (Child and Adolescent Psychiatry) mentioned telehealth in its ACGME Milestone document. According to the AAMC data the number of medical schools surveyed increased every academic year from 140 in 2013/2014 to 147 in 2017/2018, telemedicine education in medical school increased significantly from 41% in 2013/2014 to 60% in 2017/2018 (p = 0.0006). However, the growth in telemedicine education plateaued from 56% in 2015/2016 to 60% in 2017/2018 (p = 0.47). Conclusion: Familiarizing medical students with telemedicine is essential; the next generation of health care providers should be equipped with knowledge of telemedicine as a valuable skill to serve populations that do not have direct access to quality medical care. Methods of implementing telemedicine education into more medical schools and residency programs merits further study.

MyHealthyGut: Findings from a pilot randomized controlled trial on adherence to a gluten-free diet and quality of life among adults with celiac disease or gluten intolerance

Aims

The purpose of this study was to assess the effectiveness of a smartphone app (MyHealthyGut) in helping adults self-manage celiac disease or gluten intolerance and improve their gut health.

Methods

Adults diagnosed with celiac disease or gluten intolerance (N = 115) were randomized into two groups: experimental group 1 (had access to the app for a one-month period) or wait list control (WLC). After one month, WLC participants were given one-month access to the app (experimental group 2). An online questionnaire was administered to assess (a) user satisfaction with the app and (b) changes in the following patient-reported outcomes: adherence to a gluten-free diet, quality of life (QoL), self-regulatory efficacy, and feelings of depression and anxiety. Generalized estimating equations were used to assess changes in the outcome variables over time between the groups.

Results

Participants reported high levels of app usability, were satisfied with features of the app, and felt that the app was best suited for people newly diagnosed with celiac disease. Participants in the experimental groups reported improvements in adherence, gastrointestinal symptoms (experimental group 1 only), QoL, self-regulatory efficacy (experimental group 2 only), anxiety (experimental group 1 only), and depression (experimental group 2 only). Experimental group 1 and the WLC group reported significantly worse adherence after using the app based on the Celiac Dietary Adherence Test, which was in contrast to the accidental and purposeful measures of gluten consumption and symptoms for experimental group 1 but consistent with reports of accidental and purposeful gluten consumption and symptoms for the WLC group.

Conclusions

Based on feedback from the participants, the app may be best suited for individuals newly diagnosed or struggling with celiac disease or gluten intolerance. After using the MyHealthyGut app for a one-month period, adults with celiac disease reported improvements in psychosocial outcomes. Further iterations of the app are needed to meet the needs of this population better. MyHealthyGut is the first evidence-based app designed to help people with celiac disease or gluten intolerance.

The Burden of Cost in Inflammatory Bowel Disease: A Medical Economic Perspective and the Future of Value-Based Care

PURPOSE OF REVIEW

To examine the quantifiable economic impact of inflammatory bowel disease (IBD), key cost drivers and determinants, and the impact of value-based care in IBD. Finally, we prognosticate on future directions and opportunities on healthcare economics in IBD.

RECENT FINDINGS

New value-based initiatives, technologically driven interventions, and quality improvement programs have demonstrated reductions in healthcare utilization and enhanced patient outcomes, and several have realized cost of care reductions. IBD is a costly, chronic illness with unbalanced spending by a small proportion of individuals. Pharmaceutical costs are overtaking inpatient expenses as the primary cost driver. Value-based care initiatives including the IBD medical home, remote monitoring platforms such as myIBDcoach and Project Sonar, and learning healthcare networks exemplified by ImproveCareNow have all demonstrated successes in improving care quality, patient outcomes, and reduced healthcare spending in some populations. The future of value-based care in IBD is bright, with ample opportunities for model refinement, collaboration, and growth.

Mobile applications in oncology: A systematic review of health science databases

INTRODUCTION

In recent years there has been an exponential growth in the number of mobile applications (apps) relating to the early diagnosis of cancer and prevention of side effects during cancer treatment. For health care professionals and users, it can thus be difficult to determine the most appropriate app for given needs and assess the level of scientific evidence supporting their use. Therefore, this review aims to examine the research studies that deal with this issue and determine the characteristics of the apps involved.

METHODOLOGY

This study involved a systematic review of the scientific literature on randomized clinical trials that use apps to improve cancer management among patients, using the Pubmed (Medline), Latin America and the Caribbean in Health Sciences (LILACS), and Cochrane databases. The search was limited to articles written in English and Spanish published in the last 10 years. A search of the App Store for iOS devices and Google Play for Android devices was performed to find the apps identified in the included research articles.

RESULTS

In total, 54 articles were found to analyze the development of an application in the field of oncology. These articles were most frequently related to the use of apps for the early detection of cancer (n = 28), particularly melanoma (n = 9). In total, 21 studies reflected the application used. The apps featured in nine articles were located using the App Store and Google Play (n = 9), of which five were created to manage cancer-related issues. The rest of the apps were designed for use in the general population (n = 4).

CONCLUSIONS

There is an increasing number of research articles that study the use of apps in the field of oncology; however, these mobile applications tend to disappear from app stores after the studies are completed.

Digital Health Apps in the Clinical Care of Inflammatory Bowel Disease: Scoping Review

Background

Digital health is poised to transform health care and redefine personalized health. As Internet and mobile phone usage increases, as technology develops new ways to collect data, and as clinical guidelines change, all areas of medicine face new challenges and opportunities. Inflammatory bowel disease (IBD) is one of many chronic diseases that may benefit from these advances in digital health. This review intends to lay a foundation for clinicians and technologists to understand future directions and opportunities together.

Objective

This review covers mobile health apps that have been used in IBD, how they have fit into a clinical care framework, and the challenges that clinicians and technologists face in approaching future opportunities.

Methods

We searched PubMed, Scopus, and ClinicalTrials.gov to identify mobile apps that have been studied and were published in the literature from January 1, 2010, to April 19, 2019. The search terms were (“mobile health” OR “eHealth” OR “digital health” OR “smart phone” OR “mobile app” OR “mobile applications” OR “mHealth” OR “smartphones”) AND (“IBD” OR “Inflammatory bowel disease” OR “Crohn's Disease” (CD) OR “Ulcerative Colitis” (UC) OR “UC” OR “CD”), followed by further analysis of citations from the results. We searched the Apple iTunes app store to identify a limited selection of commercial apps to include for discussion.

Results

A total of 68 articles met the inclusion criteria. A total of 11 digital health apps were identified in the literature and 4 commercial apps were selected to be described in this review. While most apps have some educational component, the majority of apps focus on eliciting patient-reported outcomes related to disease activity, and a few are for treatment management. Significant benefits have been seen in trials relating to education, quality of life, quality of care, treatment adherence, and medication management. No studies have reported a negative impact on any of the above. There are mixed results in terms of effects on office visits and follow-up.

Conclusions

While studies have shown that digital health can fit into, complement, and improve the standard clinical care of patients with IBD, there is a need for further validation and improvement, from both a clinical and patient perspective. Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge. New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses.

A Web-Based Telemanagement System for Improving Disease Activity and Quality of Life in Patients With Complex Inflammatory Bowel Disease: Pilot Randomized Controlled Trial

BACKGROUND

The reported efficacy of telemedicine in patients with inflammatory bowel disease (IBD) is inconsistent among studies, and data for complex IBD are lacking.

OBJECTIVE

We aimed to evaluate the impact of remote monitoring using a Web system-Telemonitorización de la Enfermedad de Crohn y Colitis Ulcerosa or Telemonitoring of Crohn's Disease and Ulcerative Colitis (TECCU)-as compared to standard care and telephone care on health outcomes and health care in patients with complex IBD.

METHODS

We performed a 3-arm randomized controlled trial. Adult patients with IBD who received immunosuppressants and biological agents were recruited from the IBD Unit of a tertiary university hospital. The patients were randomized into groups to receive remote monitoring (G_TECCU), nurse-assisted telephone care (G_NT), or standard care with in-person visits (G_control). All patients completed the study visits at baseline and at 12 and 24 weeks in addition to each type of intervention. The primary outcome was the percentage of patients in remission at 24 weeks. Secondary health outcomes were quality of life, medication adherence, adverse effects, satisfaction, and social activities. Data on the number of outpatient visits and telephone calls, emergency visits, hospitalizations, IBD-related surgeries, and corticosteroid courses were also collected.

RESULTS

A total of 63 patients were selected (21 patients in each group). During the study, 90.5% (19/21) of patients in G_control, 95.2% (20/21) in G_NT, and 85.7% (18/21) in G_TECCU were compliant to the intervention. After 24 weeks, the percentage of patients in remission was higher in G_TECCU (17/21, 81%) than in G_NT (14/21, 66.7%) and G_control (15/21, 71.4%). A higher improvement in disease activity was observed in G_TECCU than in G_control in terms of the Harvey-Bradshaw/Mayo (odds ratio=0.12, 95% CI=0.003-2.162, P=.19) and Harvey-Bradshaw/Walmsley (odds ratio=0.11, 95% CI=0.004-1.55, P=.13) indexes. Improvement in disease activity was associated with a larger reduction in fecal calprotectin values in G_TECCU compared to G_control (estimated intervention effect: odds ratio=-0.90; 95% CI=-1.96 to 0.16, P=.11). All completers adhered to treatment in G_TECCU. In addition, the quality of life, social activities, and satisfaction improved in all 3 groups. Although the number of outpatient visits and telephone calls was lower in G_TECCU than in G_NT and G_control, the safety profile was similar in all 3 groups.

CONCLUSIONS

This pilot clinical trial suggests that the TECCU Web-based system is a safe strategy for improving health outcomes in patients with complex IBD and reducing the use of health care resources.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02943538; https://clinicaltrials.gov/ct2/show/NCT02943538 (Archived by WebCite at http://www.webcitation.org/746CRRtDN).