Use of Telemedicine To Follow Symptoms and Disease Course in Patients with Gastroparesis: A Pilot Study

Abstract

Purpose: Chronic disease care, such as in gastroparesis, requires ongoing communication between patient and physician. Telemedicine eliminates geographic constraints and allows convenient access between patients and physicians. Remote patient monitoring through telemedicine has improved outcomes in disorders such as diabetes, heart failure and hypertension; but has not been used to any great extent in GI disorders. Aims: 1) To set up an operational Internet-based telemedicine system for convenient patient reporting of symptoms. 2) To evaluate the feasibility of monitoring symptoms of patients with gastroparesis. Methods: In this pilot longitudinal study of patients with gastroparesis, a HIPAA compliant Internet-based telemedicine system was devised and used to follow patients’ symptoms. Symptoms of gastroparesis were monitored using 9 symptoms modified from the Gastroparesis Cardinal Symptom Index (GCSI). Patients rated their symptoms – none, very mild, mild, moderate, severe, very severe. In addition, diabetic patients could report blood glucose levels. Selected patients were asked to participate and given a short instructional session on how to use the internet-based telemedicine system. They were asked to enter their symptoms on a frequent basis, at least 3 times a week. Results: Ten patients with symptoms of gastroparesis were recruited to participate (9 idiopathic gastroparesis, 1 diabetic gastroparesis). During the 2-month monitoring period, 8 of the 10 patients reported their symptoms using this Internet-based telemedicine system. The number of days the patients entered their symptoms averaged 18 ± 16 [mean ± SD] with a range of 2 to 48 sessions per patient. Interestingly, some patients had stable symptoms, whereas other patients had periods of symptom exacerbations. Increases in symptom scores were seen prior to patient visits to emergency rooms and hospitalizations. In addition, decreases in symptom scores were seen with instituting new treatments in some patients. Conclusion: This pilot study shows that an Internet-based telemedicine system can be used to follow patients’ symptoms. Use of telemedicine may be useful to follow individual patient symptoms – both monitoring for symptom exacerbations and symptom response to treatments. This discrete data compiled on a regular basis over a long period provides a unique insight into the disease course of patients with gastroparesis.