Govert Veldhuijzen

170 Chapter 9 SCOPE OF THE THESIS This thesis focused on the concept of eHealth in clinical medicine. In this thesis, I described the inception, development and implementation of an eHealth intervention targeting patient education before endoscopy. In the first chapters I presented the testing phase of the prototype, organizational and medicolegal effects and the subsequent development into web based education at home. 1-3 In the following chapters, I discussed the results of the multicenter study that evaluated this intervention and showed that this intervention comes with potential savings. 4 Next, I presented a proof of concept study during endoscopy on a different eHealth intervention. Finally, our group investigated a tool to improve measurements to evaluate satisfaction of new eHealth interventions in endoscopy. MAIN FOCUS 1. To develop an eHealth intervention for patient education prior to endoscopy 2. To implement the eHealth intervention in daily practice, identifying key factors for success 3. To evaluate relevant outcome measures for assessing the effect of eHealth interventions SUMMARIZING MAIN FINDINGS Development of computer based education In chapter 2 our group conducted a pilot study on computer assisted instruction (CAI) in the hospital followed by a short nurse contact versus nurse counselling alone. The main outcome, cleanliness of the colon during examination, was measured with both the Ottawa Bowel Preparation Scale (OBPS) and Boston Bowel Preparation Scale (BBPS). We assessed patient comfort and anxiety at three different time points. In total we included 385 patients: 197 received traditional nurse counselling and 188 received CAI. Overall patient response rates were 99%, 76.4% and 69.9% respectively. Endoscopists scored cleanliness in 60.8%, leaving 39.2% of the patients with missing scores. Comparative analysis of the missing scores showed no significant difference on age, gender or educational level. In the analysed group of 60.8% baseline characteristics were evenly distributed over the groups. Bowel cleanliness was satisfactory and did not differ amongst groups: nurse vs. CAI group scores in BBPS: (6.54 ±1.69 vs. 6.42 ±1.62); OBPS: (6.07 ±2.53 vs. 5.80 ±2.90) Patient comfort scores were significantly higher (4.29, ± 0.62 vs. 4.42, ± 0.68) in the CAI group shortly before colonoscopy. Anxiety and knowledge scores were similar. We concluded that CAI is a safe and practical tool to instruct patients in the hospital before colonoscopy. At that time, we recommended the combination of CAI in the hospital followed by a short nurse contact for daily practice.