Purpose

Due to the COVID-19 pandemic, we transitioned from an in-person bowel management program (BMP) to a telemedicine BMP. The telemedicine BMP consisted of video and/or phone call visits (remote) or a single initial in-person visit followed by remote visits (hybrid). We hypothesized that patient/family satisfaction of a telemedicine BMP would be comparable to an in-person BMP and that there would be improvement in quality of life and functional outcomes after the telemedicine BMP.

Methods

After IRB approval, demographic and outcomes data were obtained for patients who underwent the telemedicine BMP from May-October 2020. Outcomes included a parent/patient satisfaction survey, Pediatric Quality of Life Inventory (PedsQL), and parent/patient-reported outcome measures (Vancouver, Baylor, and Cleveland scores) at baseline, 1 and 3 month follow-up. Variables were compared using Chi-square or Wilcoxon–Mann–Whitney tests and a generalized mixed model was used to evaluate outcomes scores at follow-up compared to baseline.

Results

Sixty-seven patients were included in our analysis with an average age of 8.6 years (SD: 3.9). Patients had the following diagnoses anorectal malformation (52.2%), Hirschsprung's disease (20.9%), functional constipation (19.4%), myelomeningocele (6.0%), and spinal injury (1.5%). Forty-eight patients (72%) underwent the remote BMP and 19 (28%) underwent the hybrid BMP. Sixty-two percent of parents completed the satisfaction survey, with a median score of 5 (very satisfied) for all questions. Over 75% of parents said they would prefer a telemedicine program over an in-person program. There was significant improvement in the Baylor and Vancouver scores after the BMP (p < 0.01), but no difference in the PedsQL or Cleveland scores (p > 0.05). There was a significant improvement in stool continence after the BMP (p < 0.01).

Conclusion

A telemedicine BMP can be an acceptable alternative to a traditional in-person program. There was high parental/patient satisfaction and significant improvement in outcomes. Further research is needed to assess long-term outcomes.

Level of evidence

III

中文翻译：

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COVID-19 期间远程医疗肠道管理计划的结果

目的

由于 COVID-19 大流行，我们从现场肠道管理计划 (BMP) 过渡到远程医疗 BMP。远程医疗 BMP 包括视频和/或电话访问（远程）或最初的一次面对面访问，然后是远程访问（混合）。我们假设远程医疗 BMP 的患者/家庭满意度与现场 BMP 相当，并且远程医疗 BMP 后生活质量和功能结果会有所改善。

方法

在 IRB 批准后，获得了 2020 年 5 月至 10 月接受远程医疗 BMP 的患者的人口统计和结果数据。结果包括父母/患者满意度调查、儿科生活质量清单 (PedsQL) 和父母/患者报告的结果测量 ( Vancouver、Baylor 和 Cleveland 分数）在基线、1 个月和 3 个月的随访中。使用卡方检验或 Wilcoxon-Mann-Whitney 检验比较变量，并使用广义混合模型评估与基线相比的随访结果评分。

结果

67 名患者被纳入我们的分析，平均年龄为 8.6 岁 (SD: 3.9)。患者有以下诊断：肛门直肠畸形 (52.2%)、先天性巨结肠 (20.9%)、功能性便秘 (19.4%)、脊髓脊膜膨出 (6.0%) 和脊柱损伤 (1.5%)。48 名患者 (72%) 接受了远程 BMP，19 名 (28%) 患者接受了混合 BMP。62% 的家长完成了满意度调查，所有问题的中位数得分为 5（非常满意）。超过 75% 的父母表示他们更喜欢远程医疗计划而不是面对面的计划。BMP 后 Baylor 和 Vancouver 分数有显着改善 ( p  < 0.01)，但 PedsQL 或 Cleveland 分数没有差异 ( p > 0.05)。BMP 后大便可控性有显着改善 ( p  < 0.01)。

结论

远程医疗 BMP 可以作为传统面对面计划的可接受替代方案。父母/患者的满意度很高，结果也有显着改善。需要进一步的研究来评估长期结果。

证据等级

三