Can a telemedicine programme improve outcomes for teenagers with inflammatory bowel disease?
Translating evidence into better quality health services
In the run-up to Evidence Live 2016, the organisers asked health science students, junior doctors, and early career researchers to write about projects or innovative ideas that they have been part of and that deal with some of the conference’s main themes (see the box at the end of this article). This article features one of the five winners who gain a free place to attend the conference in Oxford between 22 and 24 June 2016.
Anke Heida, PhD student at the University Medical Center Groningen, the Netherlands
Telemedicine is often seen as a cost effective alternative to help patients with long term chronic conditions monitor their conditions remotely. Despite this promise, telemedicine solutions are often implemented without a solid evidence base of their efficacy.
In the Netherlands, monitoring of teenagers with inflammatory bowel disease (IBD) is traditionally done during scheduled visits, but this is usually when most patients report full disease control. IBD care could be more efficient if imminent relapses were recognised at home and if patients were seen at times of clinical need. In our study, we hypothesised that IBD-live (a telemedicine monitoring programme) could lead to fewer disease flares and lower costs.
As part of an ongoing multicentre trial, teenagers aged between 10 and 19 years with IBD were randomly assigned in either IBD-live (web-based monitoring) or usual care (three monthly visits to the outpatient clinic) groups. Teenagers assigned to IBD-live had fewer scheduled visits with their IBD team and are monitored at home using a “flarometer,” which is a questionnaire that records disease activity and faecal calprotectin measurements to estimate the probability of relapse.
The frequencies of flarometer measurements and treatment advice depend on the preceding risk stratification. Primary outcome is time to relapse. Secondary outcomes include cost effectiveness and quality of life.
At the time of writing, we have evaluated our primary outcome in 120 of 180 patients with a mean follow-up of 10 months. In this interim analysis we found no difference in time to relapse or number of relapses between web based monitoring and usual follow-up care. We expect use of IBD-live to be associated with lower costs of disease management, but what this study has shown us so far is that web based monitoring strategies such as IBD-live need to show true value before being implemented in clinical practice.
Evidence Live 2016 conference themes
- Improving the quality of research evidence
- Disentangling the problems of too much and too little medicine
- Transforming the communication of evidence for better health
- Training the next generation of leaders in applied evidence
- Translating evidence into better quality health services