Multidisciplinary Care of Pediatric Disroders of Gut-Brain Interaction in the Era of Telemedicine: Equal Patient Satisfaction and Outcomems of in-Person Vs Telemedicine Encounters

ABSTRACT

Background: Patients with Disorders of Gut-Brain Interaction (DGBI) respond best to multidisciplinary treatment. With the emergence of the Coronavirus disease 2019 (COVID-19) pandemic in 2020 and the implemented lockdown in large areas of the United States, the multidisciplinary functional abdominal pain program (FAPP) at Boston Children's Hospital for the first time switched to providing care via telemedicine. We aimed to evaluate patient satisfaction and outcomes of patients seen in a multidisciplinary telemedicine visit compared to in-person care at the time of initial evaluation and follow-up. Method(s) Prospective study in which families were given a questionnaire to evaluate the visit and treatment (satisfaction, improvement overall, of abdominal pain (Abdominal Pain Index, API) and of daily functioning (Functional Disability Index, FDI) since initial visit in the FAPP. Patients <= 18 years seen for an initial visit in the FAPP between 4/1/20 and 6/20/21 were recruited. Multidisciplinary evaluation was performed in-person or via zoom (Gastroenterology, Pain medicine, Psychology, Social services, Dietician). Initially all visits were done via telemedicine (4/1/20-7/1/2020) due to the temporary closure of outpatient clinics. Thereafter, in-person visits restarted but telemedicine visits were continued to be offered. Result(s) Patient population 41 patients completed the study. Two groups were defined based on initial visit type Group A (Gr-A = Telemedicine, n=26) and group B (Gr-B = in-person, n=15). For Gr-A, follow-up visits were via telemedicine (n=17), in-person (n=2) and 7 patients had no follow-up. For Gr-B, the follow-up visits were via telemedicine (n=9), in-person (n=4) and 2 patients had no follow up visit. Mean age of participants was 14.5+/-2.8 years with female predominance (73.2%). No significant difference was found in age, gender, race, DGBI diagnosis, presence of extra-intestinal symptoms, number of follow-up visits, baseline API or FDI between groups. Patient satisfaction with multidisciplinary care at initial visit (Figure 1) No significant differences were detected between Gr-A and Gr-B (p>0.05). Patient visit type preference Families preferred in-person visits (73%) for the first visit, but telemedicine (46%) or no preference (47%) for follow-up visits. When asked if patients were equally satisfied with telemedicine and in-person visits, 81.9% agreed, 9.1% were undecided and 9.1% disagreed. 81.9% were not worried about somethinig being missed during the telemedicine visit, while18.2% were undecided about this. When asked if patients felt telemedicine was more efficient than in-person visits, 54.6% agreed, 27.3% were undecided and 45.5% disagreed. 90.9% of patients agreed that telemedicine visits were more convenient, where 9.1% were undecided. Patient outcomes: There was no clinically significant improvement of the API score in either group (Gr-A 2.7+/-0.8 to 2.4+/-1.1, p=0.04;Gr-B 2.6+/-0.9 to 2.4+/-1.0, p=0.5) or FDI (Gr-A 13.4+/-11.2 to 13.9+/-10.5,p=0.8, Gr-B 15.4+/-10.7 to 14.3+/-8.0, p=0.8) between the initial and follow-up visit. When asked how patients felt subjectively at the time of study, there was improvement but no difference between groups Much better (Gr-A 52.6% vs Gr-B 84.6%), Better (Gr-A 47.4% vs Gr-B 15.4% ), no patients in either group reported feeling worse (p=0.07). Subjective improvement of functioning was reported in Gr-A 58.5% fair to excellent, 29.4% poor and 11.8% none, whereas in Gr-B 58.3% felt fair to excellent improvement of functioning and 41.7% continued to function poorly (p=0.4). Conclusion(s) Patients are equally satisfied with delivery of multidisciplinary care for pediatric DGBI via telemedicine and in-person, suggesting this may be a promising route for expanding delivery of care even in the post-pandemic era. Limitations of this study are the small sample size. Further the lock-down promoted lack of functioning and measures of disability such as the FDI may not be representative.