<p>Telemedicine in the Management of Inflammatory Bowel Disease: An Update</p>

Sustainable practice in gastroenterology: travel-related CO2 emissions for gastroenterology clinic appointments in Canada.

BackgroundTelemedicine 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.ObjectiveThis systematic review and meta-analysis aimed to compare the impact of telemedicine with that of standard care on the management of IBD.MethodsWe 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.ResultsA 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.ConclusionsTelemedicine 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.

BackgroundPatients with inflammatory bowel disease (IBD) have periods with flare-ups, including abdominal pain, diarrhea, bloody stools, and systemic symptoms that may negatively influence the patients’ quality of life. Hence, prompt and intensified treatment is often required, and patients need to pay attention to self-management, including easy access to health care professionals. Seeking support is essential in patients’ self-management and beneficial for their quality of life. However, patients may experience difficulties in gaining access to health care professionals by phone or email when needed. Mobile health (mHealth) interventions have been shown to support patients with flexible, timely, and ongoing communication with health care professionals. However, the most prevalent functions of current apps for patients with IBD are tracking disease symptoms and accessing information. In addition, patient and clinician involvement in the design and development of eHealth apps for patients with IBD has been limited, although engaging patients is emphasized as essential for identifying tools and functionalities that they find relevant and effective.ObjectiveThis study aimed to develop an mHealth solution for patients with IBD using participatory design to support tailored communication between patients and health care professionals.MethodsThrough participatory design, we completed 3 focus groups, 4 mock-up workshops, and 2 prototype tests involving patients, health care professionals, and an IT designer to collaboratively develop a prototype. The iterative process allowed for feedback from all stakeholders to inform the design and development. This approach facilitated ongoing refinement of the prototype until a mutually satisfactory solution was achieved. Data analysis followed the structured phases inherent to participatory design: planning, acting, observing, and reflecting.ResultsA total of 14 patients with IBD aged 18-65 years and 9 health care professionals from 2 outpatient clinics in Denmark contributed to the mHealth design. The analysis generated 6 themes of patients’ suggestions for app content: easy-access messaging, agreement overviews, self-initiated patient-reported outcomes with free text, treatment and blood test notifications, an IBD knowledge base, and self-monitoring via diary and symptom registration. An intervention that reflected users’ needs and requests to support patients’ access to and communication with health care professionals in outpatient clinics was developed. The intervention included messaging, symptom registration, notifications, questionnaires with free-text space, a knowledge base, and an appointment overview.ConclusionsThe participatory design served as a usable approach to designing and developing a tailored mHealth solution for patients with IBD and their health care professionals in an outpatient clinic. On the basis of the iterative design process with mutual learning and democratic voices, the participants had a significant impact on the solution, which reflected users’ needs and resulted in the effective adaptation of the solution to the clinical setting.

BACKGROUND Telemedicine plays an important role in the management of patients with inflammatory bowel disease (IBD), which is especially evident during the pandemic such as COVID-19. However, the exact effectiveness and efficiency of telemedicine in managing IBD is unclear. OBJECTIVE We aimed to compare the impact of telemedicine on management of IBD patients with the standard care. METHODS We systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus (search date April 22, 2020). Randomized controlled trials (RCTs) comparing telemedicine with standard care in IBD patients were included, while conference abstracts, letters, reviews, laboratory studies, or case reports were excluded. The IBD-specific quality of life (QoL), disease activity and remission rate of IBD patients were assessed as primary outcomes, and the number of clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were regarded as secondary outcomes. The Review Manage 5.3 and Stata 15.1 were used for the data analysis. RESULTS 17 RCTs (n=2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group [standard mean difference (SMD) 0.18, 95% confidence interval (CI) 0.01 to 0.34，P=0.03)]. Furthermore, the number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (SMD -0.71, 95%CI -1.07 to -0.36, P&lt;0.0001). Subgroup analysis showed that adolescents had a significantly higher IBD-specific QoL in telemedicine group than that in standard care group (SMD 0.42, 95%CI 0.15 to 0.69, I2=0%, P=0.002), while there was no significant differences between two groups among adults. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between telemedicine and standard care group. CONCLUSIONS Telemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits of IBD patients. Further researches are warranted to identify the ideal group of IBD patients who could benefit from telemedicine most.

Individuals with inflammatory bowel disease (IBD) require life-long interactions with the healthcare system. Virtual care (VC) technologies are becoming increasingly utilized for accessing healthcare services. Research related to the use of VC technology for the management of IBD in Canada is limited. This study aimed to examine the VC experiences from the perspectives of individuals with IBD and gastroenterology care providers (GCPs). A patient-oriented, qualitative descriptive approach was used. Semi-structured interviews were completed with individuals with IBD and GCPs. Data were analyzed using an inductive content analysis approach. A total of 25 individuals with IBD and five GCPs were interviewed. Three categories were identified: benefits of virtual IBD care delivery, challenges of virtual IBD care delivery, and optimizing IBD care delivery. Individuals with IBD and GCPs were satisfied with the use of VC technology for appointments. Participants believed VC was convenient and allowed enhanced access to care. However, VC was not considered ideal in some instances, such as during disease flares or first appointments. Thus, a blended use of virtual and in-person appointments was suggested for individualized care. The virtual method of connecting patients and providers is deemed useful for routine appointments and for persons living in rural areas. VC is becoming more common in the IBD care environment. Nurses are in a key position to facilitate and enhance virtual IBD care delivery for the benefit of both individuals living with IBD and providers.

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.

Background and Objectives: On 11 March 2020, our hospital adapted to the COVID-19 pandemic by becoming a temporary COVID-19 facility, leading to the suspension or delegation of non-COVID-19 services. Among the international IBD community, there were significant concerns regarding the neglect of immunocompromised IBD patients and their increased vulnerability to COVID-19. To address these challenges, the COVID-19 ECCO Taskforce recommended the implementation of telehealth. Following this recommendation, our hospital's IT department integrated audiovisual hardware and software solutions to facilitate virtual consultations. This approach enabled patients and their local physicians to receive formal reports comparable to those issued during standard in-person care. Materials and Methods: We retrospectively analyzed data from patients diagnosed with Crohn's disease and ulcerative colitis who participated in telemedicine consultations. Average distances and time saved were calculated using Google Maps, while carbon emissions and carbon footprint reductions were determined. Results: Between 11 August 2021 and 15 June 2023, 107 telehealth consultations were completed. Patients benefited from reduced travel distances, with an average saving of 168.28 km per consultation and a total reduction of 18,006 km. Travel time savings averaged 2 h and 22 min per consultation, amounting to a total of 252 h saved. The reduction in carbon emissions was calculated at 3.26 tons, equivalent to the annual absorption capacity of 109 fully grown trees, considering that an individual tree absorbs approximately 21.77 kg of CO2 annually. These findings underscore telemedicine's role in reducing environmental impact while enhancing patient convenience. Conclusions: The adoption of telehealth successfully optimized outpatient clinic operations, maintaining high-quality patient outcomes while contributing to environmental sustainability.

Wearable technology in the management of chronic diseases has emerged as a significant and growing concern in healthcare. These technologies, including smartwatches, fitness trackers, and other sensor-based devices, offer continuous monitoring and real-time data collection for individuals with chronic conditions. The data collected can include vital signs, activity levels, sleep patterns, and more, providing valuable insights into a patient's health. This trend is particularly relevant in the context of chronic diseases, such as diabetes, cardiovascular conditions, and respiratory disorders, where continuous monitoring is crucial for effective management. Wearable devices empower patients to actively participate in their healthcare by facilitating self-monitoring and promoting healthy behaviors. Healthcare providers can also leverage the data generated by these devices to make informed decisions, personalize treatment plans, and intervene proactively. However, challenges exist, such as data security and privacy concerns, the accuracy of the collected information, and the need for effective integration into existing healthcare systems. Despite these challenges, the increasing adoption of wearable technology in chronic disease management reflects a promising avenue for improving patient outcomes and reducing healthcare costs through preventive and personalized care.

Background: Telemedicine has emerged as a feasible adjunct to in-person care in multiple clinical contexts, and its role has expanded in the context of the COVID-19 pandemic. However, there exists a general paucity of information surrounding best practice recommendations for conducting specialty or disease-specific virtual care. The purpose of this study was to systematically review existing best practice guidelines for conducting telemedicine encounters. Methods: A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) of existing guidelines for the provision of virtual care was performed. Data were synthesized using the Synthesis Without Meta-Analysis (SWiM) guideline, and the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) tool was used to evaluate the quality of evidence. Results: A total of 60 guidelines for virtual care encounters were included; 52% of these were published in the context of the COVID-19 pandemic. The majority (95%) of provider guidelines specified a type of virtual encounter to which their guidelines applied. Of included guidelines, 65% provided guidance regarding confidentiality/security, 58% discussed technology/setup, and 56% commented on patient consent. Thirty-one guidelines also provided guidance to patients or caregivers. Overall guideline quality was poor. Discussion: General best practices for successful telemedicine encounters include ensuring confidentiality and consent, preparation before a visit, and clear patient communication. Future studies should aim to objectively assess the efficacy of existing clinician practices and guidelines on patient attitudes and outcomes to further optimize the provision of virtual care for specific patient populations.

Inflammatory bowel disease (IBD) is a chronic illness that is comprised of two major disorders: Crohn's disease and ulcerative colitis. Adults with IBD have adopted telehealth and mobile health (mHealth) interventions to improve their self-management skills and symptom-monitoring. This systematic review aimed to evaluate the efficacy of telehealth and mHealth interventions and explore the benefits and challenges of these interventions in patients with IBD. This review used a convergent segregated approach to synthesize and integrate research findings, a methodology recommended by the Joanna Briggs Institute for mixed-methods systematic reviews. Databases searched included PubMed, CINAHL, Embase, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. The search followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, which yielded sixteen quantitative and two qualitative articles. A narrative synthesis was performed to present the findings of quantitative and qualitative studies. Evidence from quantitative and qualitative studies was then integrated for a combined presentation. The results of quantitative analysis supported the efficacy of telehealth and mHealth interventions to improve patients' quality of life, medication adherence, disease activity, medication monitoring, disease-related knowledge and cost savings. While some participants in qualitative studies reported certain challenges of telehealth and mHealth interventions, most of the participants conferred the benefits of the interventions, including improved disease-related knowledge, communication between patients and providers, sense of reassurance, and appointment options. The evidence from quantitative and qualitative synthesis partially supported each other.