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Cited by 42Celiac Disease Research and ManagementTelemedicine and Telehealth ImplementationHealth Literacy and Information Accessibility

E-Healthcare for Celiac Disease—A Multicenter Randomized Controlled Trial

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Vriezinga, Sabine, Borghorst, Annelise, van den Akker-van Marle, Elske, Benninga, Marc, George, Elvira, Hendriks, Danielle, Hopman, Erica, de Meij, Tim +10 more·2018·The Journal of Pediatrics
DOI 10.1016/j.jpeds.2017.10.027
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Abstract

Objective To evaluate the (cost-)effectiveness of online consultations in follow-up of patients with celiac disease (CD). Study design Multicenter randomized, controlled trial involving 304 patients aged ≤25 years with CD for ≥1 year, randomized to an online (n = 156) or outpatient consultation (n = 148). An online consultation included questionnaires for symptom and growth measurement. Antitransglutaminase-type-2 antibodies were determined using a point-of-care (POC) test. Controls had a traditional consultation with antitransglutaminase-type-2 antibodies testing in laboratories. Both groups completed questionnaires concerning CD-specific health-related quality of life (HRQOL), gluten-free diet adherence, and patient satisfaction. Six months later, participants repeated HRQOL and patient satisfaction questionnaires and the POC test. The primary outcome was anti-transglutaminase-type-2 antibodies after 6 months, and the secondary outcomes were health problems, dietary adherence, HRQOL, patient satisfaction, and costs. Results The performance of the POC test was inferior to laboratory testing (2/156 positive POC tests vs 13/148 positive laboratory tests; P = .003). Health problems were detected significantly more frequently using online consultation. The detection of growth problems and dietary transgressions was similar. HRQOL (from 1 [good] to 5 [poor]) improved after online consultation (from 3.25 to 3.16 [P = .013] vs controls from 3.10 to 3.23; P = .810). Patient satisfaction (from 1 [low] to 10 [high]) was 7.6 (online) vs 8.0 (controls; P = .001); 58% wished to continue online consultations. Mean costs per participant during the studied period were €202 less for the online group (P < .001). Conclusions The primary outcome could not be tested because the POC test was unreliable. Nevertheless, our results indicate that online consultations for children and young adults with CD are cost saving, increase CD-specific HRQOL, and are satisfactory for the majority. Trial registration Trialregister.nl: NTR3688.

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  • Both E-health interventions (Text Message intervention and online consultation) positively affected self-management, quality of life, patient satisfaction, and in one study reduced health-care costs compared with conventional in-office standard of care.

    “Both interventions positively affected selfmanagement, QoL, patient satisfaction, and in one study reduced health-care costs compared with conventional in-office standard of care.”

    From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [18]

    The Abstract and Discussion report improved celiac-disease-specific quality of life and lower costs for online consultations compared with outpatient care. The Results report lower patient satisfaction in the online group than in controls, and our copy does not establish improved self-management from this intervention. This paper studies online consultations, not a text-message intervention. (LLM, conf=0.89)

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  • Three studies, of which two were randomized clinical trials, have investigated E-health in the follow-up of patients with coeliac disease.

    “Three studies (of which two were RCTs (17,18) have investigated E-health in the follow-up of patients with CD.”

    From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [18]

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Research works printed but not linked: 7

  1. van Doorn RK, Winkler LM, Zwinderman KH, Mearin ML, Koopman HM. CDDUX: a disease-specific health-related quality-of-life question- naire for children with celiac disease. J Pediatr Gastroenterol Nutr 2008;47:147-52.
  2. Bakken S, Grullon-Figueroa L, Izquierdo R, Lee NJ, Morin P, Palmas W, et al. Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire. J Am Med Inform Assoc 2006;13:660-7.
  3. Dick PT, Filler R, Pavan A. Participant satisfaction and comfort with mul- tidisciplinary pediatric telemedicine consultations. J Pediatr Surg 1999;34:137-41.
  4. Myers KM, Valentine JM, Melzer SM. Child and adolescent telepsychiatry: utilization and satisfaction. Telemed J E Health 2008;14:131-7.
  5. Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54:136-60.
  6. Bos-Touwen I, Schuurmans M, Monninkhof EM, Korpershoek Y, Spruit- Bentvelzen L, Ertugrul-van der Graaf I, et al. Patient and disease characteristics associated with activation for self-management in pa- tients with diabetes, chronic obstructive pulmonary disease, chronic heart failure and chronic renal disease: a cross-sectional survey study. PLoS ONE 2015;10:e0126400.
  7. Duplaga M. The acceptance of e-health solutions among patients with chronic respiratory conditions. Telemed J E Health 2013;19:683-91.

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Authors
Vriezinga, S., Borghorst, A., van den Akker-van Marle, E., Benninga, M., George, E., Hendriks, D., Hopman, E., de Meij, T., van der Meulen-de Jong, A., Putter, H., Rings, E., Schaart, M., Schweizer, J., Smit, M., Tabbers, M., Weijerman, M., Wessels, M., & Mearin, M. L.
Affiliations
  • Leiden University Medical Center (NL)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Medisch Centrum Alkmaar (NL)
  • Juliana Kinderziekenhuis (NL)
  • Alrijne Ziekenhuis (NL)
Corresponding author
Mearin, M. Luisa
ORCID
Venue
The Journal of Pediatrics
Publisher
Elsevier BV
Published
2018-04
Volume
195
Pages
154-160.e7
ISSN
0022-3476 (ISSN-L)
DOI
10.1016/j.jpeds.2017.10.027
OpenAlex
W2779582332
Cited by
42
References
39
Citations by year
2026: 2 · 2025: 7 · 2024: 6 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 5 · 2019: 1 · 2018: 4
FWCI
2.87
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Journal of Pediatrics (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • Pure Amsterdam UMC (acceptedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Leiden Repository (Leiden University) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
Funders
  • Dutch “Maag Lever Darm Stichting” (WO-1198)
  • ZonMW (171201006)
  • STICOON
Topics
  • Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
Keywords
celiac disease, teleconsultation, telemedicine, point-of-care testing, anti-tissue transglutaminase antibodies, cost-effectiveness, health-related quality of life, gluten-free diet adherence, patient satisfaction, children and young adults, follow-up care, growth monitoring
MeSH terms
Adolescent, Adult, Celiac Disease, Child, Child, Preschool, Cost-Benefit Analysis, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Netherlands, Patient Compliance, Prospective Studies, Quality of Life, Referral and Consultation, Treatment Outcome, Patient Satisfaction, Telemedicine, Diet, Gluten-Free, Young Adult

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