Effect upon hospital activity of the application of a continued care model centered on patients with inflammatory bowel disease

Casellas, Francesc; Borruel, Natalia; Torrejón-Herrera, Antonio; Castells, Isabel

doi:10.4321/s1130-01082012000100004

Cited by 22 publications

(6 citation statements)

References 15 publications

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“…A recent multicenter, randomized controlled trial including more than 900 patients with different subtypes of IBD showed that compared with standard care, empowerment through these systems reduces outpatient visits and hospital admissions, with potential cost savings [8]. Web-based systems are currently the most useful platforms, and their application allows development of distance care projects aimed at providing access to health care in remote areas [23,24]. These models promote collaboration and knowledge exchange between specialists, potentially reducing variability in clinical practice, and could modify the future structure of health systems if they prove to be cost-effective.…”

Section: Introductionmentioning

confidence: 99%

A Web-Based Telemanagement System for Improving Disease Activity and Quality of Life in Patients With Complex Inflammatory Bowel Disease: Pilot Randomized Controlled Trial

Hoyo¹,

Nos²,

Faubel³

et al. 2018

J Med Internet Res

127

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BackgroundThe reported efficacy of telemedicine in patients with inflammatory bowel disease (IBD) is inconsistent among studies, and data for complex IBD are lacking.ObjectiveWe aimed to evaluate the impact of remote monitoring using a Web system—Telemonitorización de la Enfermedad de Crohn y Colitis Ulcerosa or Telemonitoring of Crohn’s Disease and Ulcerative Colitis (TECCU)—as compared to standard care and telephone care on health outcomes and health care in patients with complex IBD.MethodsWe performed a 3-arm randomized controlled trial. Adult patients with IBD who received immunosuppressants and biological agents were recruited from the IBD Unit of a tertiary university hospital. The patients were randomized into groups to receive remote monitoring (G_TECCU), nurse-assisted telephone care (G_NT), or standard care with in-person visits (G_control). All patients completed the study visits at baseline and at 12 and 24 weeks in addition to each type of intervention. The primary outcome was the percentage of patients in remission at 24 weeks. Secondary health outcomes were quality of life, medication adherence, adverse effects, satisfaction, and social activities. Data on the number of outpatient visits and telephone calls, emergency visits, hospitalizations, IBD-related surgeries, and corticosteroid courses were also collected.ResultsA total of 63 patients were selected (21 patients in each group). During the study, 90.5% (19/21) of patients in G_control, 95.2% (20/21) in G_NT, and 85.7% (18/21) in G_TECCU were compliant to the intervention. After 24 weeks, the percentage of patients in remission was higher in G_TECCU (17/21, 81%) than in G_NT (14/21, 66.7%) and G_control (15/21, 71.4%). A higher improvement in disease activity was observed in G_TECCU than in G_control in terms of the Harvey-Bradshaw/Mayo (odds ratio=0.12, 95% CI=0.003-2.162, P=.19) and Harvey-Bradshaw/Walmsley (odds ratio=0.11, 95% CI=0.004-1.55, P=.13) indexes. Improvement in disease activity was associated with a larger reduction in fecal calprotectin values in G_TECCU compared to G_control (estimated intervention effect: odds ratio=–0.90; 95% CI=–1.96 to 0.16, P=.11). All completers adhered to treatment in G_TECCU. In addition, the quality of life, social activities, and satisfaction improved in all 3 groups. Although the number of outpatient visits and telephone calls was lower in G_TECCU than in G_NT and G_control, the safety profile was similar in all 3 groups.ConclusionsThis pilot clinical trial suggests that the TECCU Web-based system is a safe strategy for improving health outcomes in patients with complex IBD and reducing the use of health care resources.Trial RegistrationClinicalTrials.gov NCT02943538; https://clinicaltrials.gov/ct2/show/NCT02943538 (Archived by WebCite at http://www.webcitation.org/746CRRtDN).

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Section: Introductionmentioning

confidence: 99%

A Web-Based Telemanagement System for Improving Disease Activity and Quality of Life in Patients With Complex Inflammatory Bowel Disease: Pilot Randomized Controlled Trial

Hoyo¹,

Nos²,

Faubel³

et al. 2018

J Med Internet Res

127

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“…Generating scientific knowledge about the life experiences and social support of those affected by Crohn's disease can help health professionals adopt a more holistic approach to their work with these patients, taking into account patient subjectivity and their perceptions about the problem . Particularly in Spain, several studies have shown the interest of this kind of proposals towards care improvement from a holistic perspective, focusing on implementing specialised units for those affected by CD . Few studies have focused on the life experiences and coping abilities from the perspective of those who have an inflammatory bowel disease (IBD).…”

Section: Introductionmentioning

confidence: 99%

“…Particularly in Spain, several studies have shown the interest of this kind of proposals towards care improvement from a holistic perspective, focusing on implementing specialised units for those affected by CD (14,15). Few studies have focused on the life experiences and coping abilities from the perspective of those who have an inflammatory bowel disease (IBD).…”

Section: Introductionmentioning

confidence: 99%

Understanding life experiences of people affected by Crohn's disease in Spain. A phenomenological approach

García-Sanjuán

Crespo

Richart‐Martínez

et al. 2017

Scandinavian Caring Sciences

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Background and objectives People affected by Crohn's disease must adapt their lives to their new chronic condition, and therefore, understanding such experience can be helpful in planning effective interventions for the affected ones. The aim of this study was to gain an insight into such experience and how they adapted in different areas of their lives, particularly in a family‐centred culture such as the Spanish one. Method A descriptive phenomenological study was conducted through in‐depth interviews to 19 people diagnosed of Crohn's disease in the province of Alicante (Spain). Once the interviews were transcribed, data were analysed using Colaizzi's seven‐step method. Results Five emergent themes were identified: self‐protection against the unknown cause; self‐training; learning to live with Crohn's disease; perceived losses associated to Crohn's disease; and relationship with others. The results portrayed a chronically ill patient who is unconscious about the chronicity and consequently must develop strategies to keep living a similar life like the one lived before. Conclusions This study revealed that people affected by Crohn's disease struggle with the fact of being a chronic patient with uncertainty about the illness and need to learn living with a chronic condition that limits their daily lives. Furthermore, the lack of Crohn's disease a professional in charge of these people's Cares such as the specific nursing role existing in other countries support in the Spanish Health System determines the loneliness those diagnosed experience to cope with the new situation.

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“…For example in Spain the Crohn colitis care unit (UACC), a care program using a remote communication system, proved its efficacy by demonstrating a decrease in the ratio of hospitalized/UACC-registered patients between the start and end of a study period. 90 The aim of these remote-care applications is to improve medical adherence and QoL of patients with IBD, which must be higher than with a standard clinical follow up. This is achieved through a better understanding of the disease by the patient, and better communication between patients and healthcare providers.…”

Section: Telemedicine In Ibdmentioning

confidence: 99%

Inflammatory bowel disease: towards a personalized medicine

Flamant

Roblin²

2018

Therap Adv Gastroenterol

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The management of inflammatory bowel disease (IBD) has been transformed over the last two decades by the arrival of tumor necrosis factor (TNF) antagonist agents. Recently, alternative drugs have been approved, directed at leukocyte-trafficking molecules (vedolizumab) or other inflammatory cytokines (ustekinumab). New therapeutics are currently being developed in IBD and represent promising targets as they involve other mechanisms of action (JAK molecules, Smad 7 antisense oligonucleotide etc.). Beyond TNF antagonist agents, these alternative drugs are needed for early-stage treatment of patients with aggressive IBD or when the disease is resistant to conventional therapy. Personalized medicine involves the determination of patients with a high risk of progression and complications, and better characterization of patients who may respond preferentially to specific therapies. Indeed, more and more studies aim to identify factors predictive of drug response (corresponding to a specific signaling pathway) that could better manage treatment for patients with IBD. Once treatment has started, disease monitoring is essential and remote patient care could in some circumstances be an attractive option. Telemedicine improves medical adherence and quality of life, and has a positive impact on health outcomes of patients with IBD. This review discusses the current application of personalized medicine to the management of patients with IBD and the advantages and limits of telemedicine in IBD.

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Effect upon hospital activity of the application of a continued care model centered on patients with inflammatory bowel disease

Cited by 22 publications

References 15 publications

A Web-Based Telemanagement System for Improving Disease Activity and Quality of Life in Patients With Complex Inflammatory Bowel Disease: Pilot Randomized Controlled Trial

A Web-Based Telemanagement System for Improving Disease Activity and Quality of Life in Patients With Complex Inflammatory Bowel Disease: Pilot Randomized Controlled Trial

Understanding life experiences of people affected by Crohn's disease in Spain. A phenomenological approach

Inflammatory bowel disease: towards a personalized medicine

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