[Frequent Internet use among Catalan patients with inflammatory bowel disease]

Inflammatory bowel disease patients' perspectives of non-medical needs

BACKGROUND

Inflammatory bowel disease (IBD) imposes a huge burden on the healthcare systems and greatly declines the patient's quality of life. However, there is a paucity of detailed data regarding information and supportive needs as well as sources and methods of obtaining information to control different aspects of the disease from the perspectives of the patients themselves. This study aimed to establish the IBD patients' preferences of informational and supportive needs through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

METHODS

IBD patients were recruited from different centers. Considering inclusion and exclusion criteria, 521 participants were filled a predefined questionnaire. This questionnaire was prepared through literature review of the recent well-known guidelines on the needs of IBD patients, which was further approved by the experts of IBD area in three rounds of Delphi consensus. It includes 56 items in four sections of informational needs (25), supportive needs (15), sources of information (7), and methods of obtaining information (9).

RESULTS

In particular, EFA was used to apply data reduction and structure detection. Given that this study tries to identify patterns, structures as well as inter-relationships and classification of the variables, EFA was utilized to simplify presentation of the variables in a way that large amounts of observations transform into fewer ones. Accordingly, the EFA identified five factors out of 25 items in the information needs section, three factors out of 15 items in the supportive needs section, two factors out of 7 items in the information sources section, and two factors out of 9 items in the information presentation methods. Through the CFA, all 4 models were supported by Root Mean Squared Error of Approximation (RMSEA); Incremental Fit Index (IFI); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); and SRMR. These values were within acceptable ranges, indicating that the twelve factors achieved from EFA were validated.

CONCLUSIONS

This study introduced a reliable 12-factor model as an efficient tool to comprehensively identify preferences of IBD patients in informational and supportive needs along with sources and methods of obtaining information. An in-depth understanding of the needs of IBD patients facilitates informing and supporting health service provision. It also assists patients in a fundamental way to improve adaptation and increase the quality of life. We suggest that health care providers consider the use of this tool in clinical settings in order to precisely assess its efficacy.

Internet and WeChat used by patients with Crohn's disease in China: a multi-center questionnaire survey

Background

Currently, WeChat is widely used in disease education for patients with Crohn’s disease (CD) in China. It is beneficial for the patients to actively engage in their disease management.

Methods

In this study, we examined the source and expectations of disease information for Chinese CD patients, analysing the content of popular WeChat public accounts and their potential association with medication adherence.

Results

Between November 24th, 2017 and April 10th, 2018, online questionnaires were sent to CD patients from eight different large urban hospitals in China. In all, 436 patients with CD were surveyed, and 342 patients responded. Patients most frequently visited Baidu (65%), WeChat (61%) and medical websites such as Haodaifu (35%) when searching for IBD-related information. Among ten WeChat IBD public accounts, the China Crohn’s and Colitis Foundation (CCCF) (73%), “IBD Academic Officer” (21%) and “IBD in love” (21%) were the most popular. CD patients were most interested in information from the internet about diet and day-to-day health-related living with IBD (83%), an introduction to the disease (80%), and medication advances and side effects (80%). The correlation between the information provided by the top five WeChat public accounts and patients’ expectations was low. Additionally, most patients (64%) had greater confidence in overcoming the disease after learning about CD through their internet searches. Medical adherence was also related to internet access and income (p < 0.05).

Conclusions

WeChat has become a major source of information for IBD education in China, but the content of WeChat didn’t fully meet patients’ expectations. Therefore, future initiatives should aim to provide high-quality information that based on patients’ demands.

Using the internet to evaluate the opinion of patients with inflammatory bowel disease with regard to the available information

BACKGROUND AND AIMS

patients need information for shared decision making. The aims of the study were to ascertain how patients with inflammatory bowel disease (IBD) felt about the information available and the way that their doctors informed them. In addition, how patients used the internet and factors that predicted a positive information evaluation were also assessed.

METHOD

a 39-item survey was designed that was distributed via the internet, principally using a Spanish Facebook site.

RESULTS

four hundred and twenty completed surveys were received. Patients rated the information available with a mean of 8 points (maximum of 10) and 71% felt that their doctor informed them well or very well. Various deficiencies were found such as little information available at the time of diagnosis (58%); doubts after seeing the specialist (70%); insufficient information about IBD complications, disease course and dietary aspects; and a lack of appropriate internet webpage recommendations from specialists or pharmacists. Patients ranked the internet fourth as an information source, followed by their specialist, patient associations and other patients. Independent predictive factors of feeling well informed (≥ 8) included age, OR 1.539 (CI 1.047-2.261), p = 0.028; education, OR 1.544 (CI 1.110-2.147), p = 0,010; IBD evolution time, OR 1.267 (CI 1.003-1,601), p = 0.047; and good or very good information from the specialist, OR 3.262 (CI 2.425-4.388), p < 0.001.

CONCLUSIONS

patients generally felt that they were well informed. However, there were aspects that needed improvement, such as information for younger patients or a lower education level, the information provided at diagnosis, information about specific or insufficiently covered IBD aspects and suggestions from doctors about high quality websites.

Can Smartphones Help Deliver Smarter Care for Patients With Inflammatory Bowel Disease?

The addition of smartphone applications to the armamentarium of tools to help manage patients with inflammatory bowel disease (IBD) has the potential to improve care in multiple ways, including enhanced disease understanding, improved adherence to medications, accessible support networks, and earlier interventions by medical professionals when problems arise. However, at present, for patients with IBD, the development of such mobile applications is still in its infancy. We conducted a review of the literature and online resources including phone application stores (Apple and Android app stores) to assess the current availability of mobile health applications for IBD patients and opportunities to increase patient engagement. We also addressed the limitations and challenges of patient and provider adoption of mobile-based technologies for IBD self-management and remote monitoring.

Biologic agents in inflammatory bowel disease - quality of internet website information

BACKGROUND/AIMS

Many patients currently seek the Internet for health-related information without discerning the quality or bias of the evidence presented. Biologic agents have become the mainstay of therapy in inflammatory bowel disease (IBD), and it is important that patients have access to high-quality information when exploring the various available agents to make informed decisions about their therapy. The primary aim of this study was to evaluate the quality of patient-searched Internet websites that describe the biologic agents used as treatment options for IBD. The secondary aim was to compare the quality of patient-searched with physician-recommended websites and to evaluate any differences.

MATERIALS AND METHODS

The DISCERN model was used to evaluate the quality of the information content of a total of 110 websites of all the biologic agents used in the treatment of IBD from July to September 2017. The first 10 "Google search" hits meeting the inclusion criteria for each agent were included. There were four additional physician-recommended websites that were evaluated for the purpose of the secondary aim of this study.

RESULTS

The mean DISCERN score among all websites combined was 3.21 out of a 5-point scale. The highest scoring website was "ema.europa.eu" at 4.13 whereas the lowest scoring website was "https://www.fda.gov" at 1.97 for Entyvio. There was no significant difference between patient-searched and physician-recommended websites, with a mean total score of 3.21 versus 3.63, respectively (P value of 0.158).

CONCLUSIONS

The combined quality of Internet web-based resources used for each drug was fairly consistent in scoring (intermediate to slightly above average). There was no significant advantage in the overall combined scores of the pooled physician-recommended websites when compared with the patient-searched websites.

EHealth Technologies in Inflammatory Bowel Disease: A Systematic Review

BACKGROUND AND AIMS

Electronic-health technologies (eHealth) such as Web-based interventions, virtual clinics, smart-phone applications, and telemedicine are being used to manage patients with inflammatory bowel disease (IBD). We aimed to: (1) Evaluate the impact of eHealth technologies on conventional clinical indices and patient-reported outcome measures (PROs) in IBD; (2) assess the effectiveness, cost-effectiveness and feasibility of using eHealth technologies to facilitate the self-management of individuals with IBD, and; (3) provide recommendations for their design and optimal use for patient care.

METHODS

Relevant publications were identified via a literature search, and 17 publications were selected based on predefined quality parameters.

RESULTS

Six randomized controlled trials and nine observational studies utilizing eHealth technologies in IBD were identified. Compared with standard outpatient-led care, eHealth technologies have led to improvements in: Relapse duration [(n = 1) 18 days vs 77 days, p < 0.001]; disease activity (n = 2); short-term medication adherence (n = 3); quality of life (n = 4); IBD knowledge (n = 2); healthcare costs (n = 4); the number of acute visits to the outpatient clinic due to IBD symptoms (n = 1), and; facilitating the remote management of up to 20% of an IBD cohort (n = 2). Methodological shortcomings of eHealth studies include heterogeneity of outcome measures, lack of clinician/patient input, lack of validation against conventional clinical indices and PROs, and limited cost-benefit analyses.

CONCLUSIONS

EHealth technologies have the potential for promoting self-management and reducing the impact of the growing burden of IBD on health care resource utilization. A theoretical framework should be applied to the development, implementation, and evaluation of eHealth interventions.

Social Media Use in Patients with Inflammatory Bowel Disease

Patients with chronic illnesses such as Inflammatory Bowel Disease (IBD) have been more keen to utilize the Internet and in particular, social media to obtain patient educational information in recent years. It is important for the gastroenterologist to be aware of these modalities and how they might affect information exchange and ultimately, disease management. This article addresses the current prevalence of social media use, advent of mobile health applications, social media usage in patients with chronic conditions, usage amongst providers, and most notably, the usage and preferences in IBD patients. Over the last decade there has been an increasing desire from patients to receive educational material about their disease through social media. We reviewed the medical literature on the quality of IBD-related information on social media. Given the disparity of information available on the Internet, we remark on the quality of this information and stress the need for further research to assess the validity of IBD information posted on social media.

Information resources used by patients with inflammatory bowel disease: Satisfaction, expectations and information gaps

BACKGROUND AND PURPOSE

Information received by IBD patients about their disease is of particular importance. The objective of the study was to determine the information resources these patients used, together with their perceived information gaps and expected preferences.

PATIENTS AND METHODS

A prospective, observational, cross-sectional study conducted on IBD patients attending 13 Spanish hospitals during 2008. Patients completed a semi-structured 52-question survey.

RESULTS

Survey was adequately completed by 379 of 385 patients (98%), of whom 57% had Crohn's disease and 43% ulcerative colitis. Mean patient age was 37.9 years (range, 16-76 years). Gastroenterologists were the most commonly used resource (98%), followed by the Internet (60%), and general practitioners (50%). More than 90% reported good to excellent satisfaction with gastroenterologists, nurses, and patients' associations. Only 56% considered their information needs to be covered. The Internet was mostly used by young patients and those with a high education level. In the future, 85% of the patients would like to receive information from the gastroenterologists, and 92% by face-to-face interviews. Patients mainly want additional information on treatment (medical and surgical), clinical manifestations, cancer, and mortality risks. They also think that they are poorly informed about their social and work rights, risks of cancer and death, and research trials.

CONCLUSIONS

Patients with IBD use and prefer gastroenterologists as the main source of information, but only half of them consider their information needs to be covered.

Internet and electronic resources for inflammatory bowel disease: a primer for providers and patients

Patients with inflammatory bowel disease (IBD) are increasingly turning to the Internet to research their condition and engage in discourse on their experiences. This has resulted in new dynamics in the relationship between providers and their patients, with misinformation and advertising potentially presenting barriers to the cooperative patient-provider partnership. This article addresses important issues of online IBD-related health information and social media activity, such as quality, reliability, objectivity, and privacy. We reviewed the medical literature on the quality of online information provided to IBD patients, and summarized the most commonly accessed Websites related to IBD. We also assessed the activity on popular social media sites (such as Facebook, Twitter, and YouTube), and evaluated currently available applications for use by IBD patients and providers on mobile phones and tablets. Through our review of the literature and currently available resources, we developed a list of recommended online resources to strengthen patient participation in their care by providing reliable, comprehensive educational material.

[Internet use among patients with gastrointestinal diseases in a general hospital]

INTRODUCTION

The internet has provoked a radical change in access to medical information. Access to medical websites among patients with gastrointestinal diseases has not been studied in our environment.

OBJECTIVE

To determine the level of access and use of internet as a source of medical information in patients with gastrointestinal diseases in our environment.

MATERIAL AND METHODS

We surveyed 699 consecutive patients, who were admitted to hospital or who were from intra- and extrahospital outpatient gastroenterology clinics.

RESULTS

Responses were obtained from 671 patients (55% women), aged from 18 to 88 years, (mean 54 +16). Thirty-six percent used the internet. There were no differences between men and women, but differences were found by age (86% >30 years vs 6%>70, p<0.005). More inpatients sought information than outpatients (77% vs 54%, p<0.005). Patients with inflammatory disease used the internet more than the remaining patients (57% vs 33%, p>0.005, OR 2.710 CI 1.628-4.511). Seventy-seven percent of men and 70% of women believed the information was less reliable than that provided by the physician. Eighty-six percent of patients would like e-mail contact with their physician. Eighty-nine percent thought the internet was useful to resolve doubts, 89% wanted the addresses of health sites and 90% wanted to receive periodic information on their disease. Patients without a university education wanted more periodic information (p = 0.01) and more information on how to search for medical information (p = 0.03).

CONCLUSIONS

One-third of patients with gastrointestinal diseases use the internet to obtain information on their disease. Patients require more information from their physician on internet health resources.

Quality of Internet-based information on gastrointestinal diseases

BACKGROUND

The Internet is becoming an increasingly common source of health information for patients.

OBJECTIVE

To examine the quality of gastrointestinal disease- and symptom-related Internet sites that might be searched by patients.

METHODS

A total of 120 websites were evaluated from July to November 2009 using the DISCERN instrument to determine the quality of content of health and treatment information.

RESULTS

There was substantial variability in the quality of Internet resources regarding gastrointestinal diseases and their symptoms. Information-based and institutional websites were rated highest. Resources related to celiac disease, colon cancer and abdominal pain scored the highest.

CONCLUSIONS

Overall, the quality of web-based resources was variable. Because patient education is important in the management of gastroenterological diseases, the increasing use of the Internet poses new opportunities and challenges for physicians.

Review article: how to control and improve adherence to therapy in inflammatory bowel disease

Any chronic disease is a risk situation for non-adherence to treatment. This results in suboptimal medication, and poor disease control. Adherence and compliance are directly related to therapeutic success, which is further complicated in inflammatory bowel disease patients. There is a wide array of circumstances that increase the likelihood of non-compliance in a given patient: difficult-to-follow treatment schedules (multiple doses and multiple drugs), insufficient patient information, longer evolution of the disease and inactive disease. Depression, male gender, active employment and living alone are also associated with poorer adherence to therapy. Monitoring drug intake is possible in many circumstances, directly or indirectly (urinary salicylate levels; erythrocyte metabolites and increased mean corpuscular volume and bilirubin in patients under azathioprine; blood levels of ciclosporin or tacrolimus). However, such measures are probably better utilized for dose adjustment and not for the identification of non-compliant patients. High-risk patients are a target group in which pre-emptive intervention could ensure better compliance. If the question of non-adherence arises, for instance, as a possible cause of therapy failure, the patient should be carefully approached. This should take into consideration factors that may be corrected and, most importantly, should aim at building a better patient-doctor relationship.

[Internet use to obtain health information among patients attending a digestive diseases office]

INTRODUCTION

The use of the Internet to gain health information has increased in Spain. This is changing the way patients access medical information and, in turn, the physician-patient relationship.

OBJECTIVES

To analyze the use of the Internet for medical purposes by patients attending a digestive diseases office and to determine the profile of patients seeking this information.

MATERIAL AND METHODS

A questionnaire was administered to consecutive patients attending a general digestive diseases office for the first time.

RESULTS

Four hundred twenty-three patients completed the questionnaire (56% women, 44% men, mean age 42.63 [15.994] years). A total of 2.4% had only not completed basic education, 14% had completed basic education, 32.8% had completed high school, 50.6% had university degrees, and 0.2% did not answer. More than three-quarters (76.4%) had a computer at home and 72% had internet access. Forty-two percent looked for health information on the internet. Seventeen percent had searched for specific information on their illnesses before consulting and 66% believed the internet is a good resource for obtaining medical information. Seventy percent would be interested in a specific web page on digestive disease topics and 75% would use e-mail to consult with their physicians. The group that most frequently looked for medical information consisted of patients aged 45 years or younger with secondary school or university education.

CONCLUSIONS

In our environment, patients with digestive diseases routinely use the Internet to search for medical information. These patients have a high degree of confidence in the information obtained and would be interested in a specific website devoted to diseases of the digestive system. The patients that most frequently searched for health information were aged less than 45 years old and had secondary school education or university degrees.