Telemedicine system reduces outpatient visits, hospitalization due to IBD
Self-management using a telemedicine system (myIBDcoach) resulted in a reduced rate of outpatient visits or hospitalizations after 1 year among individuals with inflammatory bowel disease (IBD), according to a recent study.
“This telemedicine tool systematically monitors and registers disease activity and factors affecting disease, patient-reported outcome measures, drug side-effects, and quality metrics,” said the researchers led by Dr Marin J de Jong from the Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands.
“Our findings accord with those in other chronic relapsing-remitting diseases and suggest that tight disease monitoring and early intervention in case of a relapse can prevent admission to hospital.”
At 12 months, participants whose symptoms were managed with the telemedicine method had fewer outpatient visits to a gastroenterologist or nurse compared with those managed with standard care (mean number of visits, 1.55 vs 2.34; difference -0.79, 95 percent confidence interval, -0.98 to -0.59; p<0.0001). The findings were largely driven by a reduction in gastroenterologist outpatient visits as there was no significant between-group difference with regards to outpatient visits to a nurse. [Lancet 2017;doi:10.1016/S0140-6736(17)31327-2]
Hospital admissions were also fewer among those on the telemedicine vs standard care method (n=16 vs 29; difference -0.05; p=0.046). In the telemedicine group, patients with Crohn’s disease (estimated intervention effect [EIE], -0.09; p=0.012), on biological therapies (EIE, -0.12; p=0.025), or with a disease duration exceeding 10 years (EIE, -0.08; p=0.045) had a lower likelihood of hospitalization.
Patient-reported quality of care scores were high and were comparable between groups at 12 months (8.16 [telemedicine] vs 8.27 [standard care]; p=0.411). Number of flares, emergency visits, corticosteroid treatment courses, and IBD-related surgeries was also comparable between groups, while medication adherence at 12 months was higher among patients in the telemedicine group (EIE, 0.46; p=0.0002).
Participants in this multicentre trial (conducted at four hospitals in the Netherlands) were adults (median age, 44 years) with IBD and without ileoanal pouch or ileorectal anastomosis who were randomized to standard care (n=444, 41 percent male, age at diagnosis 30.4 years) or the telemedicine approach (n=465, 42 percent male, age at diagnosis 30.7 years).
The monthly modules (weekly in the incidence of flares) on the myIBDcoach system included questions on disease activity, medication use, treatment adherence, satisfaction, and side effects, and lifestyle factors that could potentially affect disease, as well as patient-reported quality of life measures.
If the modules recorded parameters that “exceeded predefined thresholds”, an alert would be created on the administrator page of the local hospital and a healthcare provider would subsequently contact the patient within 2 working days.
“In an era of healthcare cost reduction and a rising incidence of [IBD], telemedicine systems could be a valuable tool for reorganizing [IBD] care towards more personalized and value-based healthcare,” said de Jong and co-authors.
“Implementation of telemedicine in [IBD] care bridges the gap between the healthcare workers’ requests for tight disease monitoring and continuity of care in an overburdened outpatient setting and patients’ demands for more involvement in disease management,” they said.
The short follow-up period (12 months) was a limitation, said the researchers, who called for longer follow-up to identify if the telemedicine approach is cost-effective and would result in better long-term outcomes. The researchers also suggested the potential use of telemedicine in patients with chronic relapsing-remitting diseases other than IBD.