Telemedicine app reduced gastroenterology visits for inflammatory bowel disease

The trial, which was conducted at multiple sites in the Netherlands, randomly assigned outpatients ages 18 to 75 years with inflammatory bowel disease without an ileoanal or ileorectal pouch system to standard care or the telemedicine system.

A telemedicine app for patients with inflammatory bowel disease safely reduced outpatient visits and hospital admissions, a recent study found.

The trial was conducted at multiple sites in the Netherlands and included outpatients ages 18 to 75 years with inflammatory bowel disease without an ileoanal or ileorectal pouch system. They were randomized to standard care (n=444) or the telemedicine system, called myIBDcoach (n=465). The system included monthly monitoring with questions regarding disease activity, medication use, treatment adherence and satisfaction, and side effects, as well as questions on factors affecting symptoms, including nutritional status, smoking, stress, life events, anxiety and depression, social support, physical exercise, and self-management skills. It also measured patient-reported outcomes on quality of life and work productivity.

In a year of follow-up, the telemedicine patients had a lower mean number of outpatient visits to a gastroenterologist or nurse than the standard care patients (1.55 vs. 2.34 visits; difference, −0.79 visit [95% CI, −0.98 to −0.59 visit]). Hospital admissions were also lower in the telemedicine group (0.05 vs. 0.10 admissions; difference, −0.05 admission [95% CI, −0.10 to 0.00 admission]). Both groups had high mean patient-reported quality-of-life scores, and there was no significant difference between them. There were also no significant differences in flares, corticosteroid courses, emergency visits, and surgeries.

The results show that the telemedicine tool was safe and might be useful for reorganizing care of inflammatory bowel disease to be more personalized and value-based, the study authors concluded. The lack of observed effect on quality of care and self-efficacy might be due to high baseline scores on these measures, they noted. “Although this study was done in patients with inflammatory bowel disease, the results suggest that telemedicine can measure and improve the quality and value of health care in patients with other chronic relapsing-remitting diseases,” the authors wrote.

An accompanying comment praised the study's results as a “remarkable achievement” given the heterogeneity of inflammatory bowel disease and the complexity and variability of its treatments. The commenters asked “why in 2017 should the primary site of care be the physician's office?” and called for care to be provided “at the convenience of the engaged patient.” The study and comment were published by The Lancet on July 14.