Eosinophilic Esophagitis Follow-Up Care through Telemedicine: A Pilot Study Jonathan Markowitz, MD, MSCE Chief of Pediatric Gastroenterology Center for Eosinophilic Disorders Greenville Health System

Eosinophilic Esophagitis (EoE) First recognized around 1995 Since then has become one of the most important chronic GI diseases in children Prevalence of about 60 per 100,000 children (similar to inflammatory bowel disease) Characterized by acid reflux-type symptoms, vomiting, difficulty swallowing Does not respond to usual reflux treatments Actually related to food allergies Diagnosed by endoscopy and biopsies revealing high number of allergic cells (eosinophils) in the esophagus

Managing EoE is Challenging Every patient is different Finding specialists who have expertise in treating the disease can be difficult Especially in more challenging cases Optimally, care is given from a team of providers: GI, Allergy, Psychologist, Dietitian, Feeding Therapist, Surgeon, Anesthesiologist Findings centers where all services are offered can be difficult

The Center for Eosinophilic Disorders (CED) at GHS Treat over 300 children and adolescents with EoE One of the largest centers in the country Patients from across the southeastern U.S. and beyond

Why Telehealth Is Appealing at GHS CED A large number of our patients travel from outside the area for care Much of what is accomplished during visits can be done without physical contact with the patient Nutrition counseling Review of test results Planning future food trials

The Project Visits conducted using Vidyo platform Telemedicine cart provided by SC Telehealth Alliance through a grant Pilot study of telemedicine visits in established patients with EoE SC residents Live 60 miles or more from CED Visits scheduled following procedure to review results and discuss future plans Satisfaction measured using a Likert scale following the visit

Results 17 subjects were enrolled over 1 year Family income and employment status varied All participants had access to the Internet All participants had a mobile device or home computer that could be used to access the Vidyo application

Results 100% of subjects reported feeling comfortable with the technology by the end of the visit 100% of subjects reported that the telemedicine visit saved them time and money 100% of subjects reported that they felt they spent adequate time with the physician during the visit

Results 14 of 17 subjects felt the TH visits saved stress 15 of 17 felt TH visits were as good as in person visits 17 of 17 were willing to do another TH visit

Results 13 of 17 subjects preferred TH visits to in person visits 10 of 17 felt preferred TH to phone calls 16 of 17 preferred TH to traveling for a visit

Results 7 subjects reported the TH visit saved them a day of missed work 4 subjects reported the TH visit saved them an overnight hotel stay

Summary of Successes Telehealth visits were universally well received among patients who had to travel 60 miles or more All subjects were highly satisfied with their experience The vast majority of patients felt that the program saved them time, money, and stress Almost all preferred traveling to an in person visit

Ongoing Challenges Patients scheduled for procedures need updated physical exam prior to procedure Incorporating a physical exam component through add-ons could help Would likely require families to find telehealth-ready sites locally The patients who travel the furthest for visits (and may benefit most) live out of state Licensing and payment issues for out of state patients limit utility

Acknowledgements SC Telehealth Alliance Carrie Frost, RN Amy Hayes, RN Ransome Eke, PhD SC ETV All of the patients and parents who participated http://scetv.org/blog/telehealth/2017/frequent-patients-see-doctor-video-rare-digestive-disorder