Telehealth solutions are commonly used to manage chronic diseases like diabetes, congestive heart failure, asthma, hypertension, and COPD, yet research on using telehealth for digestive diseases is lacking.
Managing Digestive Diseases With Telehealth
Telehealth has great potential to enhance the management of digestive diseases. Like patients with other chronic conditions, patients with digestive diseases often demonstrate high non-adherence rates that result in increased healthcare costs and decreased healthcare efficiency. Additionally, patients who are non-adherent are at risk for increased morbidity and decreased quality of life. By fostering improved compliance and continuous care, telehealth can improve the overall management of patients with digestive diseases.
Telehealth is particularly useful among the digestive disease patient population because chronic digestive diseases are typically characterized by a cycle of worsening symptoms followed by symptom-free periods. Telemedicine closes the gaps between visits with a healthcare provider and ensures that patients can accurately track disease progress.
Researching The Influence Of Telehealth
To demonstrate the positive influence of telehealth among the digestive disease patient population, the authors of a recent systematic review gathered all available research on using telehealth to manage digestive diseases. The researchers explored gastroenterology studies that used telemedicine resources to aid in digestive disease management.
The published review included 20 research articles that reported data with four overlapping themes: patient compliance, patient satisfaction, disease activity, and quality of life. The studies included in the review focused on at least one of five digestive diseases including, Inflammatory Bowel Disease (IBD), Ulcerative Colitis, Crohn's Disease, Irritable Bowel Syndrome (IBS), or Colorectal Cancer.
The study designs included in the review varied, with the most popular study type being randomized controlled trials. The other study types were pilot studies, prospective studies, pre/post studies, and cross-sectional studies. The mode of telemedicine also varied across studies. Telehealth delivery options included mobile phone, computer, and web based applications.
Where Does The Evidence Stand?
Upon aggregating the results from the studies, the researchers found that patient satisfaction ranged from 75% to 100%. The studies measured patient satisfaction via questionnaires or surveys. Patient satisfaction was overall high, and even the study that reported the lowest patient satisfaction (74%) found that 80% of the patients would recommend telehealth for digestive diseases to other patients.
Patient compliance varied considerably more than patient satisfaction, ranging from 25.7% to 100%. The studies reported patient compliance by collecting data on participant drop out rates, compliance questionnaires, the average number of weeks that patients were registered, visual analog scales, medical adherence, medication adherence, number of clinician visits, and the number of completed symptom diaries. High compliance rates were observed with the visual analog scale (100%), the medical adherence rating scale for irritable bowel syndrome (96%), symptom diaries for colon cancer (98.7%), medical adherence for IBD (91%), education adherence for IBD (100%), and medication adherence for Ulcerative Colitis (90%).
The low compliance rate is partly accounted for by the Morisky Medication Adherence Score, a 4 item survey that scores participants based on self-reported medication adherence behavior. The other low compliance score (25.7%) was seen in the study that used computerized cognitive behavioral therapy. The researches attributed this low rate to the website being less “user friendly” and less modern compared to other similar websites.
Several studies demonstrated improvements in disease activity among patients who participated in telehealth for digestive diseases. The way in which disease activity was measured varied according to the type of disease being researched and the study objectives. Half of the studies included in the systematic review demonstrated statistically significant improvements in disease activity. The authors of the review hypothesize that more studies did not find statistically significant findings because they had sample sizes less than 50 patients. Therefore, the studies did not have enough power to identify statistically significant changes between intervention and control groups.
Disease specific quality of life also showed improvements. Some studies demonstrated improvements in as little as 12 weeks. The studies measured quality of life using generic and disease specific quality of life measures.
Expanding The Role Of Telehealth For Digestive Diseases
Overall, the researchers concluded that telehealth technology has great potential to enhance digestive disease management, particularly in the areas of disease activity and quality of life. Due to the limited research available, the authors recommend that future research should continue to explore the role of telehealth in the management of gastrointestinal and gastroesophageal diseases.
Helsel BC, Williams JE, Lawson K, et al. Telemedicine and Mobile Health Technology Are Effective in the Management of Digestive Diseases: A Systematic Review. Dig Dis Sci. 2018 Apr 16.