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Remote care through telehealth for people with inflammatory bowel disease

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Remote care through telehealth for people with inflammatory bowel disease

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People with inflammatory bowel disease (IBD) require intensive follow‐up with frequent consultations after diagnosis. IBD telehealth management includes consulting by phone, instant messenger, video, text message, or web‐based services. Telehealth can be beneficial for people with IBD, but may have its own set of challenges. It is important to systematically review the evidence on the types of remote or telehealth approaches that can be deployed in IBD. This is particularly relevant following the coronavirus disease 2019 (COVID‐19) pandemic, which led to increased self‐ and remote‐management.

Objectives

To identify the communication technologies used to achieve remote healthcare for people with inflammatory bowel disease and to assess their effectiveness.

Search methods

On 13 January 2022, we searched CENTRAL, Embase, MEDLINE, three other databases, and three trials registries with no limitations on language, date, document type, or publication status.

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Selection criteria

All published, unpublished, and ongoing randomised controlled trials (RCTs) that evaluated telehealth interventions targeted at people with IBD versus any other type of intervention or no intervention.

We did not include studies based on digital patient information resources or education resources, unless they formed part of a wider package including an element of telehealth. We excluded studies where remote monitoring of blood or faecal tests was the only form of monitoring.

Data collection and analysis

Two review authors independently extracted data from the included studies and assessed their risk of bias. We analysed studies on adult and paediatric populations separately. We expressed the effects of dichotomous outcomes as risk ratios (RRs) and the effects of continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs), each with their 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE methodology.

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Main results

We included 19 RCTs with a total of 3489 randomised participants, aged eight to 95 years. Three studies examined only people with ulcerative colitis (UC), two studies examined only people with Crohn's disease (CD), and the remaining studies examined a mix of IBD patients. Studies considered a range of disease activity states. The length of the interventions ranged from six months to two years. The telehealth interventions were web‐based and telephone‐based.

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Web‐based monitoring versus usual care

Twelve studies compared web‐based disease monitoring to usual care.

Three studies, all in adults, provided data on disease activity. Web‐based disease monitoring (n = 254) is probably equivalent to usual care (n = 174) in reducing disease activity in people with IBD (SMD 0.09, 95% CI −0.11 to 0.29). The certainty of the evidence is moderate.

Five studies on adults provided dichotomous data that we could use for a meta‐analysis on flare‐ups. Web‐based disease monitoring (n = 207/496) is probably equivalent to usual care (n = 150/372) for the occurrence of flare‐ups or relapses in adults with IBD (RR 1.09, 95% CI 0.93 to 1.27). The certainty of the evidence is moderate. One study provided continuous data. Web‐based disease monitoring (n = 465) is probably equivalent to usual care (n = 444) for the occurrence of flare‐ups or relapses in adults with CD (MD 0.00 events, 95% CI −0.06 to 0.06). The certainty of the evidence is moderate. One study provided dichotomous data on flare‐ups in a paediatric population. Web‐based disease monitoring (n = 28/84) may be equivalent to usual care (n = 29/86) for the occurrence of flare‐ups or relapses in children with IBD (RR 0.99, 95% CI 0.65 to 1.51). The certainty of the evidence is low.

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Emergency care edit

U.S. Navy medical staff being trained in the use of handheld telemedical devices (2006).

Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile and Brazil. Aircraft and maritimeemergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse.[19]

A recent study identified three major barriers to adoption of telemedicine in emergency and critical care units. They include:

Regulatory challenges: related to the difficulty and cost of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities

Financial barrier: lack of acceptance and reimbursement by government payers and some commercial insurance carriers, which places the investment burden squarely upon the hospital or healthcare system.

Cultural barriers: occurring from the lack of desire, or unwillingness, of some physicians to adapt clinical paradigms for telemedicine applications.