Exploring the Question: "Does Empathy Work in the Same Way in Online and In-Person Therapeutic Settings?"

Providing remote psychotherapy using technology is a growing practice, especially since the outbreak of the COVID-19 pandemic. Even if in numerous studies video conferencing psychotherapy (VCP) was found to be clinically effective, some doubts continue to exist about how the psychotherapeutic alliance works in the online setting, and the characteristics of the empathic process are still poorly understood. This is an exploratory study aimed at analyzing the degree of empathy between the psychotherapist and client pair, and the degree of support perceived by the client who shall be referred to as the patient interchangeably in this study, comparing the sessions in person with those online, during the current pandemic, in order to discriminate the impact of empathy in the digital setting. The sample analyzed was composed of 23 patients with different severity of pathology engaged in online and in-person therapeutic sessions with five psychotherapists of different theoretical leanings. The scores of the support and empathy scale, obtained by both members of the psychotherapeutic couple in the two settings, were analyzed and compared. The test used belongs to an Italian adaptation of the Empathic Understanding (EU) of the Relationship Inventory. What emerged from comparing the scores was interesting: Unlike the psychotherapists, the patients perceived their therapists as significantly more empathic and supportive in the remote setting. These are rather important data, because the literature documents that client empathic perception measures represent a more accurate measure of the empathic relationship and, in general, can predict a good treatment outcome. Although these results need further investigation, they represent an important contribution in filling the scientific gap in the understanding of digital empathy. Also, this study provides new insights for future research on the characteristics and impact empathy has on the practice of remote psychotherapy.

A sample of Italian psychotherapists express their perception and opinions of online psychotherapy during the covid-19 pandemic.

The covid-19 lockdown forced psychotherapists to use videoconferencing psychotherapy (VCP). There is little literature on the relationship between VCP and the theoretical orientation of the psychotherapist. The aim of our research work is to explore to what extent the Italian therapists used VCP and how they experienced the change in setting during lockdown. A sample of psychotherapists completed an on-line questionnaire including data about any previous experience of remote work, information on changes in setting during lockdown and their opinions on this experience. In the second phase, a statistical analysis of the data collected was performed with SPSS. The most represented theoretical orientations are psychoanalytic, Gestalt, systemic-relational and psychodynamic. Almost all the respondents had chosen to change the setting, opting for remote work via video calls, with no differences in terms of theoretical orientation and age group. Psychotherapeutic orientation seems to affect the type of difficulties encountered. The scientific literature on remote psychotherapy (VCP) so far does not correlate it with any specific theoretical-clinical model. Our research work offers some preliminary hypotheses about potential correlations between setting variations with the theoretical-clinical models.

Direct medical cost of managing IBD patients: a Canadian population-based study.

BACKGROUND: This study aimed to quantify the direct medical cost of treating inflammatory bowel disease (IBD) in Manitoba in 2005/2006. METHODS: In all, 7375 individuals with IBD recorded in the University of Manitoba IBD Epidemiology Database were matched on age, gender, and geography to up to 10 non-IBD controls. Data for cases and controls were extracted from Manitoba Health databases in fiscal 2005/2006 for pharmaceutical, physician claims, and hospital abstracts. The mean and median expenditure were computed for the annual cost of pharmaceuticals, hospitalizations (day surgery and inpatient), and physician office visits. We assessed costs based on age, gender, type of IBD, disease duration, and level of care provided. RESULTS: In 2005/2006 the mean direct cost of an IBD case was $3896 (standard error [SE] = $90) which was twice that of controls (P < 0.05). Crohn's disease (CD; n = 3735) was significantly more costly on average than ulcerative colitis (UC; n = 3640) ($4232; SE = $137 and $3552; SE = $117, respectively, P < 0.001). The most costly cases included those within 1 year of diagnosis ($6611; SE = $593), those hospitalized overnight (15%) ($13,495, SE = $416; max = $130,332), those who had a surgical stay (2% of IBD cases) ($18,749, range = $13,413-$125,912), and those using infliximab (0.7%) ($31,440, SE = $2311; max = $96,328). For individuals using infliximab their direct annual average healthcare cost was $9683 (SE = $1745, Max = $55,208) prior to using infliximab. CONCLUSIONS: In Manitoba the direct average annual healthcare cost of CD is greater than UC and that of a patient using infliximab tends to be greater than one incurring a surgical stay.

Health service utilization in IBD: comparison of self-report and administrative data.

BACKGROUND: The reliability of self-report regarding health care utilization in inflammatory bowel disease (IBD) is unknown. If proven reliable, it could help justify self-report as a means of determining health care utilization and associated costs. METHODS: The Manitoba IBD Cohort Study is a population-based longitudinal study of participants diagnosed within 7 years of enrollment. Health care utilization was assessed through standardized interview. Participants (n = 352) reported the total number of nights hospitalized, frequency of physician contacts in the prior 12 months and whether the medical contacts were for IBD-related reasons or not. Reports of recent antibiotic use were also recorded. Actual utilization was drawn from the administrative database of Manitoba Health, the single comprehensive provincial health insurer. RESULTS: According to the administrative data, 15% of respondents had an overnight hospitalization, while 10% had an IBD-related hospitalization. Self-report concordance was highly sensitive (92%; 82%) and specific (96%; 97%, respectively). 97% of participants had contact with a physician in the previous year, and 69% had IBD-related visits. Physician visits were significantly under-reported and there was a trend to over-report the number of nights in hospital. CONCLUSIONS: Self-report data can be helpful in evaluating health service utilization, provided that the researcher is aware of the systematic sources of bias. Outpatient visits are well identified by self-report. The discordance for the type of outpatient visit may be either a weakness of self-report or a flaw in diagnosis coding of the administrative data. If administrative data are not available, self-report information may be a cost-effective alternative, particularly for hospitalizations.

Isotretinoin is not associated with inflammatory bowel disease: a population-based case-control study.

OBJECTIVES: There is anecdotal evidence that isotretinoin use is associated with development of colitis. We aimed at determining whether there is an association between isotretinoin use and development of inflammatory bowel disease (IBD). METHODS: The population-based University of Manitoba IBD Epidemiology Database and a control group matched by age, sex, and geographical residence were linked to the provincial prescription drug registry, a registry that was initiated in 1995. The number of users and duration of isotretinoin use were identified in both IBD cases and controls. RESULTS: We found that 1.2% of IBD cases used isotretinoin before IBD diagnosis, which was statistically similar to controls (1.1% users). This was also similar to the number of IBD patients who used isotretinoin after a diagnosis of IBD (1.1%). There was no difference between isotretinoin use before Crohn's disease compared with its use before ulcerative colitis. CONCLUSIONS: Patients with IBD were no more likely to have used isotretinoin before diagnosis than were sex-, age-, and geography-matched controls. Although there may be anecdotes of isotretinoin causing acute colitis, our data suggest that isotretinoin is not likely to cause chronic IBD.

Utilization of health-care resources by patients with IBD in Manitoba: a profile of time since diagnosis.

OBJECTIVES: We tested the hypothesis of nonlinear longitudinal trends in health-care utilization by individuals with Crohn's disease (CD) and ulcerative colitis (UC) in Manitoba. METHODS: Administrative databases were used to report resource use in 2000/1. A total of 5,485 cases of CD and UC and 45,279 matched controls were separated into incident cases (0-2 yr of disease), cases with longstanding disease (3-10 yr), and cases with very longstanding disease (>10 yr). Relative risk ratios (RRR) indicating the likelihood of resource use, given disease duration, were computed using multinomial logistic regression analysis. Sensitivity analysis was conducted to test the robustness of results to altering the disease duration cutoffs. RESULTS: Independent of disease duration, in general, outpatient utilization was over twice as likely among IBD cases compared with controls whether or not the contact was made for IBD-specific reasons. The likelihood of utilization was greatest among incident cases for outpatient visits with an internist (RRR 6.16, 95% CI 5.11-7.43) and surgical visits (RRR 3.78, 95% CI 3.14-4.55). Inpatient stays for IBD-specific reasons in general were considered dependent on disease duration; in particular, there was a fourfold higher likelihood for the incident cases relative to their controls. For non-IBD-specific reasons, IBD cases were 1.5 times as likely to have inpatient stays, regardless of disease duration. CONCLUSIONS: Our results suggest that within the first 2 yr from disease diagnosis the most costly resources were employed. We can likely measure the greatest proportion of treatment effects on resource use within a relatively short period.

Health care resource utilization in inflammatory bowel disease.

BACKGROUND & AIMS: The aim of this study was to quantify temporal changes in health care utilization by a population-based cohort of IBD. METHODS: By using the University of Manitoba IBD Epidemiology Database we assessed utilization of outpatient and hospital services, estimating relative risk (RR) of utilization for IBD cases compared with a matched cohort of non-IBD controls and for CD versus UC. We tested differences in utilization between prevalence cohorts 1990-1991 and 2000-2001. Also, utilization of the 1987-1988 incidence cohort was followed forward 15 years from diagnosis. The probability, intensity, and volume of utilization were estimated. RESULTS: In 2000-2001, IBD patients compared with controls were more likely to have an outpatient visit (RR, 1.18; 95% confidence interval [CI], 1.17-1.19) and an overnight hospital stay (RR, 2.32; 95% CI, 2.16-2.49). CD cases were more likely than UC cases to be hospitalized (RR, 1.26; 95% CI, 1.11-1.43) and had a greater number of outpatient visits. From 1990-1991 to 2000-2001, IBD cases experienced a significant decrease in the likelihood of an outpatient surgical visit relative to non-IBD controls (P < .05), and for those cases who were hospitalized, CD cases tended to be less likely than UC cases to experience IBD-specific inpatient surgery (P < .07). Of the 1987-1988 incidence cohort, 80% of admissions that occurred during the follow-up period were during the first 5 years after diagnosis. CONCLUSIONS: In 2000-2001, health care utilization continued to be higher in IBD versus controls and CD versus UC; however, the gap in costly service utilization appeared to narrow between the latter pair.

Utilization of health care resources by individuals with inflammatory bowel disease in the United States: a profile of time since diagnosis.

BACKGROUND: There are no cost studies of inflammatory bowel disease (IBD) that describe its impact on resource utilization or treatment costs over long periods of time. Our aim was to determine if there are observable trends in health-care resource utilization by adults with IBD depending on disease duration. METHODS: The 1999 U.S. National Health Interview Survey (n = 30,801; N = 195,398,057) included 256 adult cases with IBD who indicated the number of years since the onset of disease. Cases were grouped according to the "number of years with IBD" to distinguish between recent diagnosis (0-5 yr with IBD), long-standing IBD (6-15 yr with IBD), and very long-standing IBD (16-62 yr). A group of non-IBD controls was established and age and gender were controlled for through logistic regression analysis. Odds ratios were computed for resource use including hospitalization, health provider contact, and prescription medication. Population estimates were computed, while accounting for the complex survey design. RESULTS: When compared with the general population, IBD patients were more likely to visit a specialist and to use prescription medication regardless of disease duration. GP visits were more likely until 15 yr with diagnosed IBD [0-5 yr with IBD: OR = 2.26; 95% CI = (1.21-4.21); 6-15 yr with IBD: OR = 2.73; 95% CI = (1.17-6.37)]. Home care was more likely in the IBD population with long-standing disease [OR = 3.21; 95% CI = (1.22-8.40)]. An emergency room visit [OR = 2.41; 95% CI = (1.49-3.88)] and hospitalization [OR = 2.34; 95% CI = (1.38-3.96)] were more likely in the first 5 yr since diagnosis as was hospitalization and surgical intervention [OR = 2.14; 95% CI = (1.09-4.19)]. CONCLUSION: Specialist physicians are visited by IBD patients, and prescription medications are provided to treat IBD patients throughout their lives. This is a statistically significant trend that is viewed from onset of the disease to up to 62 yr with IBD. Our results also suggest, at least tentatively, that patients within the first 5 yr after the onset of the disease have a stronger tendency than the general population to visit an emergency room, to be hospitalized, and to have been both hospitalized and to have had surgery. If these results were borne out by further studies, then this would indicate that we can measure the greatest proportion of treatment effects on these resources within a relatively short period.

Lifetime costs for medical services: a methodological review.

OBJECTIVES: Guidelines for economic evaluation studies recommend that modeling be undertaken to estimate long-term, downstream costs. In this study, we conduct a review of a sample of studies that estimated the lifetime medical care costs for a variety of conditions. METHODS: We developed a categorization of the elements for a lifetime-costing study and based on these elements, we abstracted information from a sample of 33 papers in the following areas: study subject, purpose, scope, methods (including time profile, utilization, and cost), and results. RESULTS: We analyzed papers that were observational, models or that combined the two approaches. The time profiles were estimated from registry and published data. Utilization data were obtained from administrative data, chart reviews, and professional opinion. Costs were obtained from administrative and financial records and were estimated using all charges, allocated costs, and provider payments. We noted wide variations in methods and reporting practices. CONCLUSIONS: Following current guidelines (CCOHTA), lifetime models can be more easily interpreted and applied if investigators are more clear in their study aims, if they incorporate assumptions that are based on current data, if they follow current methodological practices (such as deflation, discounting, and sensitivity analyses), and if reporting is more transparent.

Work losses related to inflammatory bowel disease in the United States: results from the National Health Interview Survey.

BACKGROUND: U.S. studies using varying methodologies have reported different estimates for the indirect, or nonmedical cost per person with inflammatory bowel disease (IBD). Our analysis contributes to this literature by using the 1999 sample of the National Health Interview Survey (NHIS) to estimate the work-loss effect of IBD on work in the United States and the associated cost to society. METHODS: A weighted logistic regression model was used to estimate the OR of being out of the labor force as determined by predictive variables, including having been diagnosed with IBD, with or without symptoms. Controls included health status indicators and demographic variables. For those people in the labor force, a second analysis was performed to determine the relative influence of the same variables on working less than 12 months versus the entire year. SUDAAN 8.0 was used to generate population estimates, systematically correcting for survey design. RESULTS: Of IBD patients who had experienced symptoms in the past 12 months, 31.5% reported being out of the labor force (OR = 2.14, relative to the non-IBD group). We estimated the excess in the nonparticipation rate attributable to IBD with symptoms in the past 12 months in the United States to be 12.3%. Based on this, the indirect cost of nonparticipation attributable to IBD in 1998/1999 was more than $3.6 billion U.S. dollars (USD) or $5228 USD per person with IBD and symptoms. According to the second weighted logistic regression, for those who are in the labor force, having IBD had no association with the duration of work. CONCLUSIONS: By using directly observed data in our analysis, this method of estimation can be used to predict the overall paid-employment burden of IBD.

Work losses related to inflammatory bowel disease in Canada: results from a National Population Health Survey.

OBJECTIVE: Few studies have assessed the influence of inflammatory bowel disease (IBD) on work loss or estimated the costs related to work loss. Our analysis reports the employment effects related to IBD as based on the 1998 sample of the Canadian National Population Health Survey (NPHS). METHODS: Our predictive analysis adapts the theory of labor supply to a health context. Respondents between the ages of 20 and 64 who reported that they had been diagnosed by a health professional to have "a bowel disorder such as Crohn's disease or colitis" were distinguished from the other respondents. A logistic regression model was used to estimate the OR for labor force nonparticipation and variables predictive of it in the case of IBD. For those people in the labor force, the Cox proportional hazard model was used to determine whether having IBD and similar bowel disorders had an effect on the number of months of continuous employment. RESULTS: Of the IBD patients 28.9% reported labor force nonparticipation, which was a greater proportion than the non-IBD respondents (18.5% nonparticipation). The OR was 1.20 (95% CI = 1.19-1.21) for nonparticipation of IBD patients versus non-IBD patients controlling for potentially confounding factors. We estimated the excess nonparticipation attributable to IBD and similar bowel disorders in Canada to be 2.9%. Based on this, the indirect cost of nonparticipation attributable to IBD in 1998 was >$104.2 million Canadian dollars. According to the second regression using the Cox proportional hazard model, IBD and similar bowel disorders were not significantly related to the number of months worked until a break in employment was reported. Thus, there was no excess work loss among those who were employed that was associated with IBD. CONCLUSIONS: By using directly observed data in our analysis, this method of estimation can predict the overall burden of IBD and similar bowel disorders, controlling for the effect of other potentially influential characteristics.

The effect of renal insufficiency on workforce participation in the United States: an analysis using National Health and Nutrition Examination Survey III data.

BACKGROUND: End-stage renal disease is associated with workforce nonparticipation, but no previous study has assessed the impact of renal insufficiency on employment status from a population standpoint. METHODS: To determine whether renal insufficiency is independently associated with labor force participation, an analysis was performed using observational data from the Third National Health and Nutrition Examination Survey, which represents a cross-sectional sample of the US population. Five thousand five hundred fifty-eight subjects of the civilian noninstitutionalized US population aged 18 to 64 years provided complete information regarding key variables. A logistic regression equation with workforce participation as the dependent variable was created. Explanatory variables included age, sex, race, marital status, census region, and education, as well as the health-state indicators of general health status, presence or absence of diabetes, hypertension, stroke, congestive heart failure, myocardial infarction, and an indicator of renal function. Renal dysfunction was defined by serum creatinine values greater than 1.7 mg/dL (150 micromol/L) for women and greater than 2.0 mg/dL (180 micromol/L) for men. RESULTS: Renal dysfunction was independently associated with labor force nonparticipation, with an odds ratio of 7.94 (95% confidence interval, 1.60 to 39.43). This relationship remained statistically significant after subjects with markedly elevated serum creatinine levels were excluded. CONCLUSION: A previously unrecognized independent association between renal function and labor force participation was identified. This group of patients warrants further attention regarding identification of specific factors leading to nonemployment, potential for workforce rehabilitation, and assessment of the impact of renal insufficiency in other functional spheres.