F A C UL T Y O F HE AL T H A ND ME D I C A L S C I E N C E S U N I V E R S I T Y O F C O P E N H A G E N Telemedinsk udvikling Motivational Interviewing Sygeplejerskens rolle - i centrum af ehealth Fagligt Selskab for Gastroenterologiske Sygeplejersker Professor Pia Munkholm & IBD specialist nurse Dorte Marker University of Copenhagen
Motivational Interviewing Network of Trainers William R. Miller and Stephen Rollnick in Virginia, USA (2008) Interest: to improve the quality and effectiveness of counseling & consultations with clients about behavior change. Research focus on: Good practice in efforts to promote change and behaviour change among patients, clients and the practitioners who serve them(1998) Motivation is not seen as static but as dynamic. It is purposeful, intentional, and positive-directed toward the best interest of self (1983) Stepen Rollnick, Professor of Healthcare Communication at Cardiff University, clinical psychologist
DEEP-Danish Ehealth & Epidemiology group UC SCCAI 43/55% Agressive 20% Agressive 9% agressive: relapse every year 3/1% FC Moderate 36% Moderate 70% Moderate: Half of the years in inactive stage 19/6% Indolent 44% Mild 21% Mild-indolent: Inactive since diagnosis or the majority of the years 32/37% TIBS= SCCAI + FC Crohns disease/ulcerative colitis 8 years Crohns disease/ulcerative colitis 10 years Deep remission SCCAI <1 FC<100mg/kg P Munkholm SJG 1995, E Langholz Gastro 1994(UC) IC Solbjerg. CGH 2007(CD); SJG 2009(UC) Pedersen N. IBD 2014, DMJ 2015, Elkjaer M. DMJ 2012
Study methods: assessment of damage Extent x Severity
Digestive Damage Progression of digestive disease damage (Lémann score) and inflammatory activity Stricture Fistula/abscess Surgery Stricture Inflammatory Activity (CDAI, CDEIS, CRP) Disease onset Pre-clinical Diagnosis Early disease Clinical CDAI: Crohn's Disease Activity Index; CDEIS : Crohn s Disease Endoscopic Index of Severity; CRP: C-Reactive Protein Pariente B et al. Inflamm Bowel Dis 2011;17(6):1415-22
Download for free www.dmj.dk
Web-epidemiology & web-applications EPIDEMIOLOGIC web-databases 1. Povl Riis 1958-87, FU 1997 2. DCCD; Danish Crohn Colitis Database 1998-2014 3. EpiCom, European Database 2010-2015, 32 centre, web epidemiological database 4. CSO, MD, Ph.D Johan Burisch burisch@gmail.com ehealth web-applications www.constant-care.dk(uc any 5asa) 2 www.cd.constant-care.dk (CD IFX) 4 www.meza.constant-care.dk(mmx meza) 3 www.ibs.constant-care.dk(lowfodmap) 5 www.ibs-ibd.constant-care.dk(lfd) www.young.constant-care.dk(ibd children) www.egastro.constant-care.dk(kih any) 1 www.ibs-c.constant-care.dk(constipation) www.cd-ada.constant-care.dk(adalimumab) 6 Elkjaer M. EJGH 2009
Why ehealth? SMART phone Fecal Calprotectin Homemoni toring Disease activity Selfinitiate Compliance Adherence
ehealth adjuvant & achivement Goal Mucosal healing Change of natural disease course Adherence/compliance QoL PRO personal reported out-come Recognition of a relapse Self-initiate 5asa high dose for 1 month Shorten time to remission Acheivements 2014 IBD, IBS & IBS-IBD Mucosal healing by FC, fecal calprotectin NDC-yet to be proven long-term Adherence/compliance QoL PRO by web-app solution Recognition of a relapse Self-initiate 5asa high dose for 1 month Shorten time to remission Elkjaer M. Dan Med J 2012, Pedersen N. Dan Med J 2013
TRAFIC LIGHT WEB-APPLICATION Elkjaer M. APT 2009 Self-initiated MMX Mezavant 12 weeks Pedersen N. IBD 2014, Elkjaer M. EJGH 2010
Can we during partner ship deminish disease activity over time? Change of the natural disease score MD Standard care WEB-Doctor ibd nurse/patient Conventionel Course ehealth web-app
ehealth: diminish inflammation burden? Disease course: Standard care ehealth web-app Treatment begin Days(range) 0 78 days (range (46-108) 0 17 days 0 10 days 0 7 days (range 10-21) MD WEB DOCTOR/PATIENT/NURSE Elkjaer M. GUT 2010
Clinical Integrated Home Monitoring Home-monitoring, screening 1 -symptomscore -fecal calprotectin CIH Patient contact/ IBD nurse IBD Call center Standard therapy Hospital visit with monitoring at outpatient clinic -symptomscore -feces calprotectin 0 6 month Vinding KK, Marker D. 2014 in progress
egastro, CIH: Lead time bias 1 ehealth influencing time, disease course & disease damage WEB group n=125 pts Home monitoring: symptomscore + Feces Relapse confirmed by trafic light scoring Lead time Crohn & Colitis ulcerosa randomised Expected remission-time Standard care, no screening CONTROL n=125 pts Relapse bleeding/pain Relapse confirmed only by symprtomscore at out-patient clinic Consultation & treatment Expected remission-time Inactive disease No symptoms/bleeding/pain
ehealth: UC 1 year any 5-asa 2 Elkjaer M. GUT & Dan Med J 2012
ehealth: UC non-adherent to 5-asa 3 QoL Fecal Calprotectin SCCAI Pedersen N. IBD 2014 & Dan Med J 2015
ehealth: Crohns infliximab 1 year 4 QoL Inflammation Burden Pedersen N. APT 2012
5 ehealth: IBS IBS lowfodmap, Lactobac Rhamnosus, Danish nutrition Pedersen N. WJG 2014 & 2015
ehealth: IBS-IBD 6 Pedersen N. WJG 2015, GUT 2015, Dan Med J 2015
ehealth: IBS-IBD decreasing of FODMAPS (gram) 6 Pedersen N. WJG 2015, GUT 2015, Dan Med J 2015
Future ehealth ehealth CIH-Clinical Integrated Homemonitoring Standard care egastro egravid u- og kompliceret ekol ediabetes ehealth Homemonitoring & individualized therapy Patient empowerment compliance Self-initiated treatment 5asa Treat to target-mucosa healing Health platform EPIC Patient access Staff access
Tak Invitation: Phd forsvar PANUM 16/1-15, kl 14 Dorte Marker, forskningssygeplejerske Hanne Fuglsang, bioanalytiker Tina Sørensen, bioanalytiker Tine Thokilgaard, stud med Louise Maagaard, stud med Line Molzen, stud med Henriette Elsberg, stud med Sara Al-Nawas, stud med Zsuzsanna Vegh, MD (Hungary) Johan Burisch, ph.d., læge Kristoffer Kofod Vinding, læge, ph.d. stud. Katrine Carlsen, læge, Ph.d. stud. Natalia Pedersen, overlæge, Phd Pia Munkholm, Professor