Introduction
Telemedicine could be an effective tool in the management of chronic diseases such as IBD, by allowing a two-way, real-time interactive communication between the patient and the physician at the distant site. The Covid 19 outbreak and the social distancing rules led the clinicians to seek for a remote monitoring approach, capable of guaranteeing an adequate follow-up of domiciliary patients.
Aims & Methods
The aim of our study was to develop a telemedicine system suitable for IBD patients, and to verify the effectiveness of the system comparing two different groups of patients, whose follow up was done via the telemedicine platform or via standard care, respectively, in the IBD clinic of our tertiary referral center.
A pre-existing platform MyHospitalHub Pro used for the remote monitoring of Covid19 patients was adapted in order to include suited parameters for IBD patients. Young patients, with an adequate educational level, who lived far from our center and with a mild disease activity or in remission were asked for participating in the study. One group was enrolled in the telemedicine group. The control group included patients with similar characteristics who refused the remote approach. . Furthermore, we evaluated disease activity using the validated questionnaire MIAH (Monitor IBD At Home questionnaire), and the satisfaction index of patients followed by telemedicine using the TSQM (Treatment Satisfaction Questionnaire for Medication) at baseline and after six months
Results
Seventy-six patients were enrolled in the study, 38 followed through telemedicine, and 38 followed through standard care. The two populations had the same characteristics at baseline: 71 % (54) had Crohn disease, 29 % (11) had ulcerative colitis; 55 % (21) were males, and 13% (5) were smokers. The MIAH score was significantly higher in the telemedicine group than in the standard care group at baseline (mean±DS 4.82±3.98 vs 1.82±2.24 p<0,001). No significantly differences were observed in both groups after six months. Moreover, the telemedicine group showed a significant improvement in MIAH score than the control group (mean difference -1.78 [IC95% da -2,92 a -0,65]; (p=0,003). As for the TSQM, 97% of the patients followed by telemedicine were satisfied and would be willing to carry out the visits in this modality. Looking at corticosteroid courses, emergency room access, and seek for medical advice, they were 5 (13%), 0, 8 (21%) in the telemedicine group, and 3 (7,9%), 1 (2,6%), 10 (26%) in the standard care group, respectively.
Conclusion
Our study confirms that telemedicine, using dedicated platforms and objective evaluation scores, is a valuable method to manage patients with IBD, especially those who have a mild disease. Its use could be implemented in clinical practice, since is a safe and feasible application well accepted by the patient. Moreover, it could lead to a reduction of indirect costs of treatment, an increased patient engagement, a reduction in the overcrowding of the IBD clinics, and a facilitation of early intervention for symptoms and signs of active inflammation.
