Telemedicine based on patient-reported outcomes in management of patients with inflammatory bowel disease in a real-life setting – a before and after cohort study

Abstract

Background

Avoidable appointments and increasing incidence of inflammatory bowel disease (IBD) call for alternative ways of organizing outpatient visits. In controlled studies, telemedicine including patient reported outcome (PRO) has shown to improve outcomes in IBD and reduce health care utilization. However, we lack studies of telemedicine implemented in everyday practice. We therefore described use of a PRO-based telemedicine follow-up (AmbuIBD) in a real-life setting and investigated the effect on outpatient visits and hospital admissions.

Methods

We conducted a cohort study including patients with IBD in an outpatient clinic at a Danish regional hospital August 2018. Data included extracts from the Patient Administration System and the AmbuFlex system between 2017 and August 2018, plus questionnaire data from clinicians. Descriptive statistics were used to describe use of AmbuIBD and differences between before and after results were tested with Wilcoxon’s signed-rank test.

Results

Of 848 patients in outpatient care, 77% were included in AmbuIBD. Most patients were set to answer a PRO questionnaire once a year (n = 407, 62%), and 66% of 1913 answered questionnaires were handled with no further contact. AmbuIBD was well accepted by clinicians. Outpatient visits the year after AmbuIBD compared to the year before were reduced with 14% (p ≤ .001). The largest reduction was for patients with mild or no disease activity (45%, p ≤ .001). No difference was found for hospital admissions.

Conclusions

AmbuIBD is feasible and well accepted when implemented in an outpatient clinic. More than half of patients are only followed by questionnaire, and we found a reduction in outpatient visits.

Keywords:

• Inflammatory bowel disease
• telemedicine
• patient-reported outcome measure
• e-health
• optimized patient pathway

Acknowledgements

We thank Andrew Bolas for his assistance in data management, and AmbuFlex for delivering the system and support, expertise and engagement in developing AmbuIBD.

Disclosure statement

The authors have no conflict of interest to disclose.

Additional information

Funding

This work is supported by The Ministry of Health (Denmark).