Valutazione dell'efficacia e del ridotto impatto ambientale della telemedicina impiegata quale tecnica di consultazione medica nella celiachia rispetto alle consultazioni tradizionali in presenza

Abstract Background: Healthcare systems contribute significantly to greenhouse gas emissions, with patient travel accounting for approximately 10% of this footprint [1]. Telemedicine (TM) has emerged as a viable solution to reduce emissions. This study aimed to compare the environmental impact, costs, and satisfaction associated with TM versus face-to-face (FTF) visits for follow-up of pediatric patients affected with celiac disease (CD). Methods: All children with a diagnosis of CD (2-16 years) attending follow-up visit were invited to choose between FTF or TM visits conducted via Google Meet. Data on carbon footprint, cost, usability and satisfaction [Telehealth Usability Questionnaire (TUQ)], and Celiac Dietary Adherence Test (CDAT) were collected using a Google Form. Results: From March 2023 to November 2024, 654 eligible patients were invited and 131 were analyzed, after excluding who refused to participate and incomplete data (58 TM, 73 FTF). There was no significant difference in baseline characteristics between the two groups (gender, age and respondent: mother, father, adolescent or child, P: NS). CDAT scores were similar in TM and TFT groups (p = 0.9). TM visits were shorter (median 30, 25-40 min) than FTF (75 |55;95| min) (p < 0.001). CO2 emissions were significantly lower for TM than for FTF (0.08 |0.07-0.11| vs. 24.00 |10.50-39.00| kg) (p < 0.001). Lost working days (10 [18.9%], 43 [81.1%]; p < 0.001) and total costs (€0.55, €15.7; p < 0.001) were also lower for TM than for FTF. The median TUQ scores indicated high overall satisfaction (Median scores: Ease of Use and Learnability: 21, Satisfaction and Future Use: 26, Interface Quality: 25, respectively) resulting in highest ratings. However, Reliability score was low (median score: 16), suggesting potential issues with system stability or consistency in user experience. Conclusions: TM offers a sustainable alternative to traditional follow-up visits for CD, reducing CO2 emissions, costs, and patient burden in terms of working days and time consuming. The patient’s satisfaction is very high. The findings of the present study support the wider use of TM in CD anagement, aligning healthcare practices with environmental sustainability goals.

Background: La pandemia da SARS-CoV-2 ha incentivato l’uso della telemedicina nei follow-up clinici. Questo studio valuta efficacia e impatto ambientale della telemedicina (TM) rispetto alle visite in presenza (FTF) in pazienti pediatrici con celiachia. Metodi: Pazienti celiaci tra 2-16 anni, seguiti presso il nostro ambulatorio, hanno ricevuto una visita di follow-up FTF o TM, tramite Google Meet. Sono stati raccolti dati su CO₂ emessa, costi e soddisfazione, tramite un modulo online. L’impronta ambientale è stata stimata usando 157g di CO₂/ora per la TM, e specifici calcolatori per i mezzi di trasporto delle FTF. I partecipanti TM hanno compilato anche il questionario TUQ. Risultati: Su 654 pazienti invitati, 139 hanno dato consenso; 8 esclusi per dati incompleti. La coorte finale ha incluso 131 pazienti (58 TM, 73 FTF). Nessuna differenza significativa tra i gruppi per età, genere, aderenza alla dieta (CDAT). Il tempo visita è risultato inferiore in TM (30 min vs 75 min, p<0.001), così come le emissioni di CO₂ (0,08 kg vs 24,00 kg, p<0.001). I giorni lavorativi persi erano minori in TM (10 vs 43, p<0.001). I costi medi erano inferiori in TM (€0,55 vs €15,7, p<0.001). I punteggi del TUQ mostrano alta soddisfazione e usabilità della TM Conclusioni: La telemedicina si conferma una valida alternativa alle visite tradizionali nei pazienti pediatrici con celiachia. Riduce tempi, costi e impatto ambientale, mantenendo un’elevata soddisfazione. Offre benefici in termini di qualità assistenziale e sostenibilità.