Subjects

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 versus 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 health care 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. Health care 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.

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Author information

Affiliations

  1. University of Maryland School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, MD, USA

    • Raymond K. Cross MD, MS
    • , Leyla Ghazi MD
    • , Seema A. Patil MD
    • , Sandra M. Quezada MD, MS
    • , Katharine Russman
    • , Mahrukh Riaz MPH
    • , Guruprasad Jambaulikar MBBS, MPH
    •  & Barathi Sivasailam MD
  2. University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD, USA

    • Patricia Langenberg PhD
    • , J. Kathleen Tracy PhD
    • , Joseph F. Collins PhD
    •  & Charlene C. Quinn RN, PhD
  3. University of Pittsburgh, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Pittsburgh, PA, USA

    • Miguel Regueiro MD
  4. Vanderbilt University, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Nashville, TN, USA

    • David A. Schwartz MD
    • , Dawn Beaulieu MD
    •  & Sara N. Horst MD, MPH
  5. Veterans Affairs Cooperative Studies Program, Perry Point, MD, USA

    • Joseph F. Collins PhD
  6. CircleLink Health LLC, Norwalk, CT, USA

    • Jonathan Katz

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Guarantor of the article

Raymond K. Cross, MD, MS.

Specific author contributions

Raymond K. Cross: planning and/or conducting the study, collecting and/or interpreting data and/or drafting the manuscript. Patricia Langenberg: planning and/or conducting the study, collecting and/or interpreting data and/or drafting the manuscript. Miguel Regueiro: planning and/or conducting the study, collecting and/or interpreting data. David A. Schwartz: planning and/or conducting the study, collecting and/or interpreting data, J. Kathleen Tracy: planning and/or conducting the study, collecting and/or interpreting data. Joseph F. Collins: planning and/or conducting the study, collecting and/or interpreting data. Jonathan Katz: planning and/or conducting the study, collecting and/or interpreting data. Leyla Ghazi: planning and/or conducting the study, collecting and/or interpreting data. Seema A. Patil: planning and/or conducting the study, collecting and/or interpreting data. Sandra M. Quezada: Planning and/or conducting the study, collecting and/or interpreting data. Katharine Russman: planning and/or conducting the study, collecting and/or interpreting data. Mahrukh Riaz: planning and/or conducting the study, collecting and/or interpreting data. Guruprasad Jambaulikar: planning and/or conducting the study, collecting and/or interpreting data. Barathi Sivasailam: planning and/or conducting the study, collecting and/or interpreting data. Charlene C. Quinn: planning and/or conducting the study, collecting and/or interpreting data. All authors approved the final draft submitted.

Financial support

This research was supported by the Agency for Healthcare Research and Quality (1R01HS018975-01A1) and the University of Maryland General Clinical Research Centers Program. The University of Maryland General Clinical Research Centers Program participated in data collection.

Potential competing interests

None.

Corresponding author

Correspondence to Raymond K. Cross MD, MS.

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DOI

https://doi.org/10.1038/s41395-018-0272-8