Telemedicine and Integrated Multidisciplinary Care for Pediatric IBD Patients: A Review

Potthoff, Lauren M.

doi:10.3390/children8050347

Cited by 5 publications

(3 citation statements)

References 49 publications

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“…TH allows the provision of clinical care through virtual patient consultations and patient education, remote monitoring, wireless health applications, and electronic transmission of imaging and medical reports (41,42). The literature demonstrates equivalent to superior health outcomes with virtual care (43)(44)(45)(46)(47). The advantages of TH include consistently improved access, adherence, and education (self-efficacy) in adolescents at reduced costs through fewer in-person visits (43).…”

Section: Discussionmentioning

confidence: 99%

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Statement for Telehealth

Franciosi

Berg

Rosen

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Telehealth (TH) broadly encompasses remote activities of clinical care (telemedicine), provider and patient education, and general health services. The use of synchronous video for TH first occurred in 1964 and then catapulted to the forefront in 2020 during the coronavirus disease 2019 public health emergency. Due to the sudden need for increased TH utilization by nearly all health care providers at that time, TH became essential to clinical practice. However, its sustainable future is unclear in part given that best practices for TH in pediatric gastroenterology (GI), hepatology, and nutrition remain undefined and non-standardized. Key areas for review include historical perspective, general and subspeciality usage, health care disparities, quality of care and the provider-patient interaction, logistics and operations, licensure and liability, reimbursement and insurance coverage, research and quality improvement (QI) priorities, and future use of TH in pediatric GI with a call for advocacy. This position paper from the Telehealth Special Interest Group of North American Society of Gastroenterology, Hepatology and Nutrition provides recommendations for pediatric GI-focused TH best practices, reviews areas for research and QI growth, and presents advocacy opportunities.

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Section: Discussionmentioning

confidence: 99%

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Statement for Telehealth

Franciosi

Berg

Rosen

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

View full text Add to dashboard Cite

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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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“…Interprofessional teams that are able to work together in one location have been seen to optimize role clarification and support integrated health services [ 52 ]. Furthermore, the function of provider empowerment evolved during the course of implementation; as providers became more aware of their roles, their empowerment enabled increased patient recruitment and ease of program delivery coupled with integration within the existing workflow of the clinic [ 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study

Sibbald

Misra

daSilva

et al. 2022

BMC Health Serv Res

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Background In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care. Methods We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. Results We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. Conclusions This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.

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Telemedicine and Integrated Multidisciplinary Care for Pediatric IBD Patients: A Review

Cited by 5 publications

References 49 publications

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Statement for Telehealth

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Statement for Telehealth

Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care

A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study

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