1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Acknowledgements SC Telehealth Alliance Carrie Frost, RN Amy Hayes, RN
Ransome Eke, PhD
SC ETV
All of the patients and parents who participated