Telehealth interventions in patients with chronic liver diseases: A systematic review

Abstract

Background and Aim: Telehealth interventions may improve access to care, disease-specific, and quality outcomes in chronic liver diseases (CLDs). We aimed to systematically evaluate outcomes of telehealth interventions in CLDs. Materials and Methods: We used key terms and searched PubMed/ EMBASE from inception to January 10, 2022. Two authors independently screened abstracts. Disagreements were resolved by a third reviewer. We included any type of CLD, including posttransplant patients, and extracted outcomes as defined by authors for each etiology of CLD (sustained virological response in HCV or weight loss in NAFLD). Meta-analysis was not performed because of the heterogeneity of data. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for clinical trials.Results: Of 4250 studies screened, 43 met the inclusion criteria. Of these, 28 reported HCV treatment outcomes. All studies showed no statistically significant differences between sustained virological response rates in TH groups compared with control groups or historic cohorts. Eight studies evaluating liver transplant-related processes and outcomes demonstrated improved rates of transplant evaluation and referrals and decreased shortterm readmission rates. Three randomized controlled trials and 1 observational study on NAFLD showed improved weight loss outcomes. One retrospective study showed reduced mortality risk in CLD patients with at least 1 TH encounter.

How to improve preventive health care in patients with cirrhosis

“…[9] TM has also made its way into the transplant referral process; a recent systematic review of TM interventions in patients with CLD identified 8 studies reporting on TM-related liver transplantation referrals, evaluations, and listings demonstrating both decreased time from referral to evaluation and listing. [10] The benefits of TM are apparent; it can improve and optimize access to medical care for disadvantaged patient populations, reduce patient travel, and expedite care for patients with CLD. The limitations include (a) difficulty in navigating TM for older adults due to media device literacy, (b)access to the internet, and (c) uncertainty regarding insurance reimbursement for the services provided.…”

“…A large observational study of Veterans Affairs population with CLD enrolled in Specialty Access Network‐Extension of Community Healthcare Outcome (the SCAN‐ECHO) study showed decreased risk of mortality in 518 patients compared to 62,237 controls with no visits (HR of 0.54 [95% CI: 0.36–0.81, p = 0.003]) 9 . TM has also made its way into the transplant referral process; a recent systematic review of TM interventions in patients with CLD identified 8 studies reporting on TM-related liver transplantation referrals, evaluations, and listings demonstrating both decreased time from referral to evaluation and listing 10 …”

Advances in Multidisciplinary Approach for Liver Cancer

“…Telehealth platforms often enable patients open up to express their needs while on therapy in and out of the treatment center. The multidisciplinary team members could also monitor the patient's clinical and psychological status by sharing signs and symptoms from the patient to healthcare providers [56][57][58].…”