A Randomized Controlled Trial of TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD).

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 Under 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