Applying Telemedicine to Multidisciplinary Pediatric Inflammatory Bowel Disease Care

Michel, H; Maltz, Ross; Boyle, Brendan; Donegan, Amy; Dotson, Jennifer L.

doi:10.3390/children8050315

Cited by 6 publications

(3 citation statements)

References 35 publications

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“…Care delivered via telemedicine has inherent limitations including the inability to complete hands-on physical examinations, collect anthropometrics, obtain point-of-care testing, and administer medications and immunizations. Additionally, consultation with ancillary service providers may be affected, though multiple publications have cited successful implementation of multidisciplinary care in pediatric IBD via telemedicine, and a recent publication outlined best practices for the application of telemedicine in pediatric gastroenterology care (49)(50)(51).…”

Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care

Michel

Gorham

Lee

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Outpatient inflammatory bowel disease (IBD) care shifted from office visits (OV) to a model with integrated telemedicine during the 2020 COVID-19 pandemic. We describe the impact of this shift on delivery of pediatric IBD care. Methods: We collected electronic medical record data from office and telemedicine visits for pediatric patients with IBD at a single center April 2019-December 2020. We compared visit volume, duration, and test ordering between 2019 and 2020, and between OV and telemedicine, and assessed for differences in telemedicine adoption by sociodemographic factors. Results: Visit volume was maintained between 2019 and 2020. Median overall appointment time was shorter for telemedicine vs. OV (46 (IQR 35-72) vs. 62 (IQR 51-80) minutes; P<0.001) with no significant difference in time spent with provider (28 (IQR 21-41) vs. OV 30 (IQR 24-39) minutes; P=0.08). Accounting for drive time, telemedicine visits were 2.6 times shorter than office visits in 2020 (P<0.001). In univariate analyses, there was no difference in telemedicine utilization by race or gender. Variables significantly associated with telemedicine were older age, English as primary language, being non-Hispanic, commercial insurance, living in an area of very high opportunity, and having a longer drive time to the office (P<0.05 for all comparisons). In multivariate analyses, visits among patients with commercial insurance were significantly more likely to be conducted via telemedicine (P=0.02). Among those with a telemedicine visit, multivariate analyses demonstrated multiracial patients were significantly more likely to have video visits (vs. audio-only; P=0.02), while patients with public insurance, no or missing insurance, and whose primary language was Arabic were significantly less likely to have video visits (P<0.05 for all comparisons). Conclusions: Integrated telemedicine allowed for continued delivery of pediatric IBD care and significantly decreased appointment time. While telemedicine may improve access for those who live further from the office, concerns remain about the introduction of disparities.

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Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care

Michel

Gorham

Lee

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

Self Cite

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“…Although robust evidence is lacking in defining IBD MDT membership, guidelines provide some framework including identifying core and ancillary members ( 12 , 15 , 44 , 52 , 53 ). Core individuals for IBD-specific IMCs include nurses ( 12–14 , 34 , 41 , 42 , 44 , 52–75 ), mental health care providers such as psychologists and psychiatrists ( 33 , 41 , 53–55 , 57 , 62 , 63 , 66–68 , 70 , 74 , 76–80 ), dietitians ( 14 , 34 , 41 , 44 , 52 , 53 , 55 , 57 , 59 , 66–68 , 70 , 72 , 74 , 75 ), and social workers ( 53 , 55 , 57 , 62 , 66 , 67 , 70 ). Pathologists, radiologists, and pharmacists with a special interest in IBD have also been suggested as core members of an IMC ( 44 ).…”

Section: Integrated Collaborative Models Of Carementioning

confidence: 99%

The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care

Mathias,

Rohatinsky,

Murthy

et al. 2023

Journal of the Canadian Association of Gastroenterology

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Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56–66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.

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“…Subjects with stable disease on maintenance therapy could adequately be managed by a scheduled program of telemedicine [ 17 ]. The sudden SARS-CoV-2 pandemic represented an urgent need to test and implement telemedicine services, even for pediatric IBD [ 20 , 21 ]. The results of the SIGENP multicenter cohort study showed that specific telemedicine services for children with IBD were activated in 52.3% of the participating centers [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Pediatric Gastroenterology and Hepatology in Italy before and after the COVID-19: Lessons learned and management changes by SIGENP

et al. 2023

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AbstractAround the world, the 2019 Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised serious public health problems and major medical challenges. The Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) published several papers on the impact of COVID-19 on the current management, diagnosis, and treatment of acute and chronic gastrointestinal, hepatic, immune-mediated, and functional disorders. The present article summarizes the most relevant SIGENP reports and consensus during and after the peak of the COVID-19 outbreak, including the diagnosis and treatment of inflammatory bowel disease (IBD), indications and timing of digestive endoscopy, and insights into the novel hepatitis.

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Applying Telemedicine to Multidisciplinary Pediatric Inflammatory Bowel Disease Care

Cited by 6 publications

References 35 publications

Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care

Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care

The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care

Pediatric Gastroenterology and Hepatology in Italy before and after the COVID-19: Lessons learned and management changes by SIGENP

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