NEW YORK (Reuters Health) – Telemonitoring of young patients with inflammatory bowel disease (IBD) can save healthcare resources without increasing the risk of flares, new research shows.
“This strategy is attractive for teenagers and families, and health professionals may be interested in using it to keep teenagers who are well out of hospital and ease pressure on overstretched outpatient services,” Dr. Patrick van Rheenen of the University of Groningen, the Netherlands, and colleagues state.
Conventional monitoring of IBD is done through outpatient visits scheduled at the physician’s discretion, the researchers note. However, most flares occur between these visits.
They developed a home telemonitoring approach intended to detect flares early. Patients receive automated email alerts to fill out their symptom score using the Pediatric Ulcerative Colitis Activity Index (PUCAI) or the shortened Pediatric Crohn’s Disease Activity Index (shPCDAI), and then send in a stool sample.
Those considered to be at low risk (symptom score <10 and stool calprotectin <250 micrograms/gram) were instructed to repeat the test in three months. Symptomatic patients with higher calprotectin levels were advised to contact their specialist. Patients in the telemedicine group also had appointments with their specialist every six months.
In their study, published online December 8 in the Journal of Crohn’s and Colitis, Dr. van Rheenen and his colleagues randomly assigned 170 patients (ages 10 to 19) with IBD to receive telemonitoring or standard follow-up care.
By one year, 33% of patients in the telemonitoring group had flares, compared to 34% of the control group. Time to flare was similar based on both intention-to-treat (ITT) and per-protocol analyses.
ITT analysis found a mean 1.32-point increase from baseline in quality of life for the telemedicine group, and a decrease of 0.32 in the standard group. Fifty-four percent of telemedicine patients said they had a positive change in their quality of life, versus 44% of the control group (P=0.27).
Telemonitoring patients saw their care provider a mean of 3.6 times over the course of the study, versus 4.3 for the control group (P<0.001). Mean annual cost savings with telemedicine were 89 euros (US$106) per patient, based on ITT analysis. For the most compliant patients, the investigators estimate annual savings per patient at 360 euros (US$427).
Patients with a higher emotional quotient and those with a longer travel distance were more likely to comply with the telemedicine protocol, with odds ratios of 1.3 and 1.2, respectively. Seventy-one percent said they would like to continue with telemonitoring.
“For participants and their parents in the intervention arm, the timesaving aspect of home telemonitoring, as well as the better sense of disease control, were highly valued,” Dr. van Rheenan and his colleagues write. The approach could be made more cost-effective, they add, by extending the interval between blood tests for patients on immune-modulating drugs and aminosalicylates.
Dr. van Rheenen was not available for an interview by press time.
SOURCE: http://bit.ly/2CMBhqN
J Crohns Colitis 2017.
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