A Randomized Controlled Trial of TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD)

Abstract

INTRODUCTION: Telemedicine has shown promise in inflammatory bowel disease (IBD). The objective of this study was to compare disease activity and quality of life (QoL) in a 1-year randomized trial of IBD patients receiving telemedicine vs. standard care. METHODS: Patients with worsening symptoms in the prior 2 years were eligible for randomization to telemedicine (monitoring via texts EOW or weekly) or standard care. The primary outcomes were the differences in change in disease activity and QoL between the groups; change in healthcare utilization among groups was a secondary aim. RESULTS: 348 participants were enrolled (117 control group, 115 TELE-IBD EOW, and 116 TELE-IBD weekly). 259 (74.4%) completed the study. Age was 38.9 ± 12.3 years, 56.6% were women, 91.9% were Caucasian, 67.9% had Crohn’s disease (CD) and 42.5% had active disease at baseline. In CD, all groups experienced a decrease in disease activity (control −5.2 ± 5.0 to 3.7 ± 3.6, TELE-IBD EOW 4.7 ± 4.1 to 4.2 ± 3.9, and TELE-IBD weekly 4.2 ± 4.2 to 3.2 ± 3.4, p < 0.0001 for each of the groups) In UC, only controls had a significant decrease in disease activity (control 2.9 ± 3.1 to 1.4 ± 1.4, p = 0.01, TELE-IBD EOW 2.7 ± 3.1 to 1.7 ± 1.9, p = 0.35, and TELE-IBD Weekly 2.5 ± 2.5 to 2.0 ± 1.8, p = 0.31). QoL increased in all groups; the increase was significant only in TELE-IBD EOW (control 168.1 ± 34.0 to 179.3 ± 28.2, p = 0.06, TELE-IBD EOW 172.3 ± 33.1 to 181.5 ± 28.2, p = 0.03, and TELE-IBD Weekly 172.3 ± 34.5 to 179.2 ± 32.8, p = 0.10). Unadjusted and adjusted changes in disease activity and QoL were not significantly different among groups. Healthcare utilization increased in all groups. TELE-IBD weekly were less likely to have IBD-related hospitalizations and more likely to have non-invasive diagnostic tests and electronic encounters compared to controls; both TELE-IBD groups had decreased non-IBD related hospitalizations and increased telephone calls compared to controls. DISCUSSION: Disease activity and QoL, although improved in all participants, were not improved further through use of the TELE-IBD system. TELE-IBD participants experienced a decrease in hospitalizations with an associated increase in non-invasive diagnostic tests, telephone calls and electronic encounters. Research is needed to determine if TELE-IBD can be improved through patient engagement and whether it can decrease healthcare utilization by replacing standard care.

Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic

“…There has been rapid uptake by services of telephone clinics, and some centres have instituted video consultations. Previous studies [15][16][17] have assessed the impact of telemedicine systems in IBD assessing feasibility, patient acceptance, effectiveness and impact on healthcare utilisation. However, there are several potential barriers 18 and further adoption and upscaling of teleconsultation tools are urgently warranted.…”

React, reset and restore: Adaptation of a large inflammatory bowel disease service during COVID-19 pandemic

“…We used telephone clinics, but the development of video consultations will be a welcome addition. While telehealth modalities have previously been used in IBD, 19 the pandemic will accelerate their adoption.…”

Adaptation of TECCU App Based on Patients´ Perceptions for the Telemonitoring of Inflammatory Bowel Disease: A Qualitative Study Using Focus Groups

“…They were reluctant to answer excessive close-ended questionnaires, and they preferred to receive continuous follow-up and personalized feedback adapted to their particular evolution, which is similar to patients in other studies [30,45]. In this sense, we maintained the questionnaires to classify the patients' health status, but we also adapted simple and validated PROs previously used for telemonitoring of IBD patients [17,18,[40][41][42][43][44]. Additionally, some specific terms were presented through text and images so that they were more easily understood.…”

“…They wanted to connect with their usual caregivers and rejected the idea of changing medication based only on "machine-made decisions." These findings are striking when considering that most telemonitoring apps designed for IBD patients are based on systems of alerts and preformulated action plans derived from the patents' responses to self-reported questionnaires [9,10,[17][18][19]. In this sense, the perceptions of the patients remind us of the importance not to consider telemonitoring as an isolated tool to replace in-person visits, but, rather, an adjunct to classic follow-up procedures that potentially optimize healthcare resources [18,49].…”

“…There is often insufficient technical training for healthcare providers and patients, and there are concerns about the privacy of health data as well as confusion regarding the reimbursement system for telehealth services [13]. Moreover, and despite the potential cost-savings of eHealth in the IBD setting [14], the efficacy of such approaches in terms of disease outcomes is not consistent across studies [9,10,[15][16][17][18][19]. Remarkably, the attrition rates reported are still high despite the continued adaptation of web platforms and the evolution of mHealth over the last decade [9,[17][18][19][20].…”