Gastroenterology patients are twice troubled during the Covid-19 pandemic.
Along with the lack of access to their gastroenterologist and the fear of visiting hospitals, they are also concerned about the danger posed by their immunomodulating drugs. Many believe that they are at a higher risk of catching Covid-19 infection.
These patients are not getting as much care as they need. As their doctor, you’re concerned about them and want to help them through remote care. But you are also wondering what are the telehealth best practices for gastroenterology?
Managing digestive problems on telehealth
Gastroenterologists provide care for both acute, severe diseases and to people with mild to moderate, controlled disease. While the former need to go to a hospital or emergency room, your patients with chronic, quiescent conditions can consult you remotely.
Some patients live in rural and remote places and find it difficult to access gastroenterology specialist care. Managing digestive problems on telehealth would help these people, and enable them to save commuting time.
Outpatient visits, colonoscopies and non-urgent surgery have been postponed during the pandemic. This is especially important for IBD patients on immunomodulating drugs, to keep them safe at home. Telehealth is a boon for such people.
Since physical examination and invasive testing are not possible, you can use the following for monitoring disease activity and control (1):
• Blood tests like C-reactive protein (CRP).
• Abdominal ultrasound.
• Fecal biomarkers (calprotectin and others).
• Patient reported outcomes.
As an unintended (and non-measurable) benefit, telehealth also reduces the spread of Covid-19 among both patients and health care providers.
Video consultation best practices for gastro problems
First off, you will need to train your staff to use telehealth. They can then help first-time patients with the technology.
And secondly, when you begin an online consultation, always start by introducing yourself to the patient.
A very simple but often overlooked rule is to always look at the camera (rather than the screen) while talking to your patients.
Moreover, you must always obtain and preserve the patient’s consent for the telehealth consultation before beginning the session.
Since a physical examination is not possible, your diagnosis will be based on history, questioning and inspection. Therefore, you should take as detailed a history as possible.
Electronic Health Records (EHR) store the data of the patient and can be accessed just as easily in a video consult as in an in-person consult. This can help you in your diagnosis during video consultations.
Ask if the patients if they have a weighing machine, glucometer, blood pressure measuring device, etc. These can provide objective data for your treatment decisions.
After summarizing the treatment plan, give the patient some time for questions.
You should always be friendly and patient during the consultation. Avoid calls and other distractions during that period so that you can give your undivided attention to the patient.
But even after following all the telehealth best practices, certain diagnosis may not be possible. Does the patient seem acutely ill? In this case, you will, of course, recommend an in-person visit.
• Adequate hardware: High-definition (HD) video, good audio equipment, and a fast internet connection are needed. High-definition video helps judge conditions like dehydration, cyanosis, breathlessness, and jaundice.
• In addition to the hardware and internet connection, proper telehealth software is advisable. A good telehealth platform will be fully integrated with your practice management software, EHR and e-prescription system, and be fully HIPAA compliant.
• Careful documentation is very important because of the higher likelihood of missed diagnoses. You must also document the refusal by a seriously ill patient to go to a hospital or emergency room.
Are gastro patients satisfied with telehealth?
A study carried out before the Covid-19 pandemic found that gastroenterology patients were quite satisfied with telehealth, even as a first consultation (2). Clinical decision-making, post-visit healthcare utilization, and patient outcomes were as good as with in-person visits.
Patients are quite satisfied with the care they receive through telehealth (3). Ninety percent feel all their healthcare queries were adequately dealt with at the remote consultation and would like to use telehealth again. Half of the patients also say they saved 1-3 hours by consulting remotely.
Telehealth in gastroenterology can be successfully implemented with the right platform. Clinical decision-making, patient satisfaction, and outcomes are similar to conventional visits. Implementing these video consultation tips for gastroenterologists will help you to continue serving your patients and expanding access to underserved populations.
1. Papa A, Papa V, Lopetuso LR, Gasbarrini A, Tursi A. Covid-19 and the management of patients with inflammatory bowel disease: a practical decalogue for the post-pandemic phase. Therap Adv Gastroenterol. 2020 Oct 24;13:1756284820968747. doi: 10.1177/1756284820968747. PMID: 33149764; PMCID: PMC7586260.
2. Munroe CA, Lin TY, Rouillard S, Fox J, Lee JK, Corley DA. Influence of Telemedicine-First Intervention on Patient Visit Choice, Post-Visit Care, and Patient Satisfaction in Gastroenterology. Gastroenterology. 2020 Oct 16:S0016-5085(20)35277-X. doi: 10.1053/j.gastro.2020.10.020. Epub ahead of print. PMID: 33075348; PMCID: PMC7566667.
3. Costantino A, Noviello D, Mazza S, Berté R, Caprioli F, Vecchi M. Trust in telemedicine from IBD outpatients during the COVID-19 pandemic. Dig Liver Dis. 2020 Nov 5:S1590-8658(20)30990-7. doi: 10.1016/j.dld.2020.10.035. Epub ahead of print. PMID: 33187917; PMCID: PMC7644233.
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