Telemedicine and inflammatory bowel disease – results of the IBD Assistant pilot project

Česká verzia

Authors: Malíčková K. ^1,2; Pešinová V. ¹; Bortlík M. ^1,3,4; Ďuricová D. ^1,4; Machková N. ¹; Hrubá V. ¹; Lukáš M. Jr. ^1,5; Mitrová K. ^1,6; Vašátko M. ¹; Kostrejová M. ^1,7; Kolář M. ¹; Lukáš M. ^1,2
Authors place of work: Klinické a výzkumné centrum pro střevní záněty ISCARE a. s. a 1. LF UK Praha ¹; Ústav lékařské biochemie a laboratorní diagnostiky, 1. LF UK a VFN v Praze ²; Interní klinika, 1. LF UK a ÚVN – VFN Praha ³; Farmakologický ústav, 1. LF UK a VFN Praha ⁴; Ústav živočišné fyziologie a genetiky AV ČR, v. v. i. Liběchov ⁵; Pediatrická klinika 2. LF UK a FN Motol, Praha ⁶; Nemocnice Milosrdných sester sv. Karla Boromejského v Praze ⁷
Published in the journal: Gastroent Hepatol 2020; 74(1): 18-27
Category:
doi: https://doi.org/10.14735/amgh202018

Summary

Background: Telemedicine enables accurate and immediate monitoring of the current health state of a patient to allow well-timed and customized treatment.

Patients and Methods: A randomized controlled trial was initiated to evaluate telemonitoring of Czech inflammatory bowel disease (IBD) patients and to compare the quality of telemonitoring with that of standard health care. Adult IBD patients (N = 131) in disease remission who have not been treated previously with a biological agent were enrolled in the study. Patients were randomly assigned to the telemonitoring group (IBDA) and the control (CTRL) group.

Results: The number of outpatient visits was significantly lower in the IBDA group than in the CTRL group (mean and median number in IBDA group 0, in the CTRL group 4.2 and 4 visits, resp. P < 0.0001). Harvey–Bradshaw index/pMayo score activity indexes were not significantly different at baseline (P = 0.636 and P = 0.853) and at the end of the study (P = 0.517 and P = 0.890) between the two groups. Similarly, the levels of inflammatory markers did not differ between the two groups (C-reactive protein, P = 0.496 for IBDA group and P = 0.327 for CTRL group; Fecal calprotectin, P = 0.921 for IBDA group and P = 0.397 for CTRL group). There was no significant difference in the incidence of intercurrent infections between the two groups (0.93 vs. 0.81 cases of infection/patient/year, p = 0.87) or the need for hospitalization (1 vs. 0). The average direct annual cost of patient follow-up was approximately 25% lower in the IBDA group than in the CTRL group.

Conclusion: This first Czech IBD telemedicine study confirms the effectiveness and safety of the telemedicine approach, which leads to a reduction in outpatient visits and savings in care costs while maintaining high health care standards.

Keywords:

inflammatory bowel disease – Telemedicine – calprotectin

Zdroje

1. Dušek L, Ngo O, Májek O et al. Epidemiologie idiopatických střevních zánětů v české populaci: dostupné datové zdroje, prevalence léčených pacientů a celková mortalita. Gastroent Hepatol 2019; 73 (2): 163–166. doi: 10.14735/amgh2019163.

2. Magro F, Gionchetti P, Eliakim R et al. Third European evidence-based consensus on diag-nosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis 2017; 11 (6): 649–670. doi: 10.1093/ecco-jcc/jjx008.

3. Gomollón F, Dignass A, Annese V et al. 3rd European evidence-based consensus on the diag-nosis and management of Crohn’s disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis 2017; 11 (1): 3–25. doi: 10.1093/ecco-jcc/jjw168.

4. Jeuring SF, van den Heuvel TR, Liu LY et al. Improvements in the long-term outcome of Crohn’s disease over the past two decades and the relation to changes in medical management: results from the population-based IBDSL cohort. Am J Gastroenterol 2017; 112 (2): 325–36. doi: 10.1038/ajg.2016.524.

5. Jeuring SF, Bours PH, Zeegers MP et al. Disease outcome of ulcerative colitis in an era of changing treatment strategies: results from the Dutch population-population-based IBDSL cohort. J Crohns Colitis 2015; 9 (10): 837–845. doi: 10.1093/ecco-jcc/jjv129.

6. Colombel JF, Narula N, Peyrin-Biroulet L. Management strategies to improve outcomes of patients with inflammatory bowel diseases. Gastroenterology 2017; 152 (2): 351–361. doi: 10.1053/j.gastro.2016.09.046.

7. Lakatos PL. Prevalence, predictors, and clinical consequences of medical adherence in IBD: how to improve it? World J Gastroenterol 2009; 15 (34): 4234–4239. doi: 10.3748/wjg.15.4234.

8. Porter ME. What is value in health care? N Engl J Med 2010; 363 (26): 2477–2481. doi: 10.1056/NEJMp1011024.

9. Bradley SM, Rumsfeld JS, Ho PM. Incorporating health status in routine care to improve health care value: the VA Patient Reported Health Status Assessment (PROST) System. JAMA 2016; 316 (5): 487–488. doi: 10.1001/jama.2016. 6495.

10. de Jong M, van der Meulen-de Jong A, Romberg-Camps M et al. Development and feasibility study of a telemedicine tool for all patients with IBD: MyIBDcoach. Inflamm Bowel Dis 2017; 23 (4): 485–493. doi: 10.1097/MIB.0000000000001 034.

11. de Jong MJ, van der Meulen-de Jong AE, Romberg-Camps MJ et al. Telemedicine for management of inflammatory bowel disease (myIBDcoach): a pragmatic, multicentre, randomised controlled trial. Lancet 2017; 390 (10098): 959–968. doi: 10.1016/S0140-6736 (17) 31327-2.

12. George L, Cross R. Telemedicine platform myIBDcoach reduces hospitalisations and outpatient gastroenterology visits in patients with IBD. BMJ Evid Based Med 2019; 24 (1): 37–38. doi: 10.1136/bmjebm-2018-111000.

13. Centers for Disease Control and Prevention. Epi InfoTM. [online]. Available from: https: //www.cdc.gov/epiinfo/index.html.

14. Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet 1980; 1 (8167): 514.

15. Sutherland LR, Martin F, Greer S et al. 5-aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology 1987; 92 (6): 1894–1898. doi: 10.1016/0016-5085 (87) 90621-4.

16. Malíčková K, Pešinová V, Kolář M et al. POCT systém detekce hladin fekálního kalprotektinu při telemonitoringu pacientů s idiopatickými střevními záněty. Klin Biochem Metab 2019; 27 (48): 72–77.

17. Europen Comission. Market study on telemedicine. 3rd EU Health Programme. 2018. [online]. Available from: https: //ec.europa.eu/health/sites/health/files/ehealth/docs/2018_provision_marketstudy_telemedicine_ en.pdf.

18. Consumer Barometer Study 2017. The year of the mobile majority. [online]. Available from: https: //www.scribd.com/document/3843 02750/Google-UK-Consumer-Barometer-Study-2017-v2-1.

19. Ministerstvo zdravotnictví ČR. Národní strategie elektronického zdravotnictví. Posouzení realizovatelnosti vybraných oblastí Národní strategie elektronického zdravotnictví. [online]. Dostupné z: http: //creativecommons.org/licenses/by/4.0/.