Telemedicine and inflammatory bowel disease – results of the IBD Assistant pilot project
Karin Malíčková1,2, Veronika Pešinová3, Martin Bortlík1,4,5, Dana Ďuricová1, Naděžda Machková1, Veronika Hrubá1, Martin Lukáš1, Katarína Mitrová1,6, Martin Vašátko1, Marta Kostrejová3,7, Martin Kolář1, Milan Lukáš1
1 IBD clinical and research centre ISCARE a.s., Prague, Czech Republic
2 Institute of Medical Biochemistry and Laboratory Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
3 Klinické a výzkumné centrum pro střevní záněty ISCARE a.s. a 1. LF UK Praha
4 Department of Internal Medicine, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
5 Institute of Pharmacology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
6 Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
7 Nemocnice Milosrdných sester sv. Karla Boromejského v Praze
Background: Telemedicine enables accurate and immediate monitoring of the current health state of a patient to allow well-timed and customized treatment. Patients and Methods: A randomized controlled trial was initiated to evaluate telemonitoring of Czech inflammatory bowel disease (IBD) patients and to compare the quality of telemonitoring with that of standard health care. Adult IBD patients (N = 131) in disease remission who have not been treated previously with a biological agent were enrolled in the study. Patients were randomly assigned to the telemonitoring group (IBDA) and the control (CTRL) group. Results: The number of outpatient visits was significantly lower in the IBDA group than in the CTRL group (mean and median number in IBDA group 0, in the CTRL group 4.2 and 4 visits, resp. P < 0.0001). Harvey–Bradshaw index/pMayo score activity indexes were not significantly different at baseline (P = 0.636 and P = 0.853) and at the end of the study (P = 0.517 and P = 0.890) between the two groups. Similarly, the levels of inflammatory markers did not differ between the two groups (C-reactive protein, P = 0.496 for IBDA group and P = 0.327 for CTRL group; Fecal calprotectin, P = 0.921 for IBDA group and P = 0.397 for CTRL group). There was no significant difference in the incidence of intercurrent infections between the two groups (0.93 vs. 0.81 cases of infection/patient/year, p = 0.87) or the need for hospitalization (1 vs. 0). The average direct annual cost of patient follow-up was approximately 25% lower in the IBDA group than in the CTRL group. Conclusion: This first Czech IBD telemedicine study confirms the effectiveness and safety of the telemedicine approach, which leads to a reduction in outpatient visits and savings in care costs while maintaining high health care standards.
Keywordsinflammatory bowel disease, calprotectin, telemedicine
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