Telemedicine for management of inflammatory bowel disease (myIBDcoach): a pragmatic, multicentre, randomised controlled trial

Marin J de Jong, Andrea E van der Meulen-de Jong, Mariëlle J Romberg-Camps, Marco C Becx, Jeroen P Maljaars, Mia Cilissen, Ad A van Bodegraven, Nofel Mahmmod, Tineke Markus, Wim M Hameeteman, Gerard Dijkstra, Ad A Masclee, Annelies Boonen, Bjorn Winkens, Astrid van Tubergen, Daisy M Jonkers, Marie J Pierik

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Tight and personalised control of inflammatory bowel disease in a traditional setting is challenging because of the disease complexity, high pressure on outpatient clinics, and rising incidence. We compared the effects of self-management with a telemedicine system, which was developed for all subtypes of inflammatory bowel disease, on health-care utilisation and patient-reported quality of care versus standard care.

METHODS: We did this pragmatic, randomised trial in two academic and two non-academic hospitals in the Netherlands. Outpatients aged 18-75 years with inflammatory bowel disease and without an ileoanal or ileorectal pouch anastomosis, who had internet access and Dutch proficiency, were randomly assigned (1:1) to care via a telemedicine system (myIBDcoach) that monitors and registers disease activity or standard care and followed up for 12 months. Randomisation was done with a computer-generated sequence and used the minimisation method. Participants, health-care providers, and staff who assessed outcome measures were not masked to treatment allocation. Primary outcomes were the number of outpatient visits and patient-reported quality of care (assessed by visual analogue scale score 0-10). Safety endpoints were the numbers of flares, corticosteroid courses, hospital admissions, emergency visits, and surgeries. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02173002.

FINDINGS: Between Sept 9, 2014, and May 18, 2015, 909 patients were randomly assigned to telemedicine (n=465) or standard care (n=444). At 12 months, the mean number of outpatient visits to the gastroenterologist or nurse was significantly lower in the telemedicine group (1·55 [SD 1·50]) than in the standard care group (2·34 [1·64]; difference -0·79 [95% CI -0·98 to -0·59]; p<0·0001), as was the mean number of hospital admissions (0·05 [0·28] vs 0·10 [0·43]; difference -0·05 [-0·10 to 0·00]; p=0·046). At 12 months, both groups reported high mean patient-reported quality of care scores (8·16 [1·37] in the telemedicine group vs 8·27 [1·28] in the standard care group; difference 0·10 [-0·13 to 0·32]; p=0·411). The mean numbers of flares, corticosteroid courses, emergency visits, and surgeries did not differ between groups.

INTERPRETATION: Telemedicine was safe and reduced outpatient visits and hospital admissions compared with standard care. This self-management tool might be useful for reorganising care of inflammatory bowel disease towards personalised and value-based health care.

FUNDING: Maastricht University Medical Centre and Ferring.

Original languageEnglish
Pages (from-to)959-968
Number of pages10
JournalLancet
Volume390
Issue number10098
DOIs
Publication statusPublished - 2 Sep 2017

Keywords

  • Journal Article

Cite this

de Jong, Marin J ; van der Meulen-de Jong, Andrea E ; Romberg-Camps, Mariëlle J ; Becx, Marco C ; Maljaars, Jeroen P ; Cilissen, Mia ; van Bodegraven, Ad A ; Mahmmod, Nofel ; Markus, Tineke ; Hameeteman, Wim M ; Dijkstra, Gerard ; Masclee, Ad A ; Boonen, Annelies ; Winkens, Bjorn ; van Tubergen, Astrid ; Jonkers, Daisy M ; Pierik, Marie J. / Telemedicine for management of inflammatory bowel disease (myIBDcoach) : a pragmatic, multicentre, randomised controlled trial. In: Lancet. 2017 ; Vol. 390, No. 10098. pp. 959-968.
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abstract = "BACKGROUND: Tight and personalised control of inflammatory bowel disease in a traditional setting is challenging because of the disease complexity, high pressure on outpatient clinics, and rising incidence. We compared the effects of self-management with a telemedicine system, which was developed for all subtypes of inflammatory bowel disease, on health-care utilisation and patient-reported quality of care versus standard care.METHODS: We did this pragmatic, randomised trial in two academic and two non-academic hospitals in the Netherlands. Outpatients aged 18-75 years with inflammatory bowel disease and without an ileoanal or ileorectal pouch anastomosis, who had internet access and Dutch proficiency, were randomly assigned (1:1) to care via a telemedicine system (myIBDcoach) that monitors and registers disease activity or standard care and followed up for 12 months. Randomisation was done with a computer-generated sequence and used the minimisation method. Participants, health-care providers, and staff who assessed outcome measures were not masked to treatment allocation. Primary outcomes were the number of outpatient visits and patient-reported quality of care (assessed by visual analogue scale score 0-10). Safety endpoints were the numbers of flares, corticosteroid courses, hospital admissions, emergency visits, and surgeries. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02173002.FINDINGS: Between Sept 9, 2014, and May 18, 2015, 909 patients were randomly assigned to telemedicine (n=465) or standard care (n=444). At 12 months, the mean number of outpatient visits to the gastroenterologist or nurse was significantly lower in the telemedicine group (1·55 [SD 1·50]) than in the standard care group (2·34 [1·64]; difference -0·79 [95{\%} CI -0·98 to -0·59]; p<0·0001), as was the mean number of hospital admissions (0·05 [0·28] vs 0·10 [0·43]; difference -0·05 [-0·10 to 0·00]; p=0·046). At 12 months, both groups reported high mean patient-reported quality of care scores (8·16 [1·37] in the telemedicine group vs 8·27 [1·28] in the standard care group; difference 0·10 [-0·13 to 0·32]; p=0·411). The mean numbers of flares, corticosteroid courses, emergency visits, and surgeries did not differ between groups.INTERPRETATION: Telemedicine was safe and reduced outpatient visits and hospital admissions compared with standard care. This self-management tool might be useful for reorganising care of inflammatory bowel disease towards personalised and value-based health care.FUNDING: Maastricht University Medical Centre and Ferring.",
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author = "{de Jong}, {Marin J} and {van der Meulen-de Jong}, {Andrea E} and Romberg-Camps, {Mari{\"e}lle J} and Becx, {Marco C} and Maljaars, {Jeroen P} and Mia Cilissen and {van Bodegraven}, {Ad A} and Nofel Mahmmod and Tineke Markus and Hameeteman, {Wim M} and Gerard Dijkstra and Masclee, {Ad A} and Annelies Boonen and Bjorn Winkens and {van Tubergen}, Astrid and Jonkers, {Daisy M} and Pierik, {Marie J}",
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de Jong, MJ, van der Meulen-de Jong, AE, Romberg-Camps, MJ, Becx, MC, Maljaars, JP, Cilissen, M, van Bodegraven, AA, Mahmmod, N, Markus, T, Hameeteman, WM, Dijkstra, G, Masclee, AA, Boonen, A, Winkens, B, van Tubergen, A, Jonkers, DM & Pierik, MJ 2017, 'Telemedicine for management of inflammatory bowel disease (myIBDcoach): a pragmatic, multicentre, randomised controlled trial', Lancet, vol. 390, no. 10098, pp. 959-968. https://doi.org/10.1016/S0140-6736(17)31327-2

Telemedicine for management of inflammatory bowel disease (myIBDcoach) : a pragmatic, multicentre, randomised controlled trial. / de Jong, Marin J; van der Meulen-de Jong, Andrea E; Romberg-Camps, Mariëlle J; Becx, Marco C; Maljaars, Jeroen P; Cilissen, Mia; van Bodegraven, Ad A; Mahmmod, Nofel; Markus, Tineke; Hameeteman, Wim M; Dijkstra, Gerard; Masclee, Ad A; Boonen, Annelies; Winkens, Bjorn; van Tubergen, Astrid; Jonkers, Daisy M; Pierik, Marie J.

In: Lancet, Vol. 390, No. 10098, 02.09.2017, p. 959-968.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Telemedicine for management of inflammatory bowel disease (myIBDcoach)

T2 - a pragmatic, multicentre, randomised controlled trial

AU - de Jong, Marin J

AU - van der Meulen-de Jong, Andrea E

AU - Romberg-Camps, Mariëlle J

AU - Becx, Marco C

AU - Maljaars, Jeroen P

AU - Cilissen, Mia

AU - van Bodegraven, Ad A

AU - Mahmmod, Nofel

AU - Markus, Tineke

AU - Hameeteman, Wim M

AU - Dijkstra, Gerard

AU - Masclee, Ad A

AU - Boonen, Annelies

AU - Winkens, Bjorn

AU - van Tubergen, Astrid

AU - Jonkers, Daisy M

AU - Pierik, Marie J

N1 - Copyright © 2017 Elsevier Ltd. All rights reserved.

PY - 2017/9/2

Y1 - 2017/9/2

N2 - BACKGROUND: Tight and personalised control of inflammatory bowel disease in a traditional setting is challenging because of the disease complexity, high pressure on outpatient clinics, and rising incidence. We compared the effects of self-management with a telemedicine system, which was developed for all subtypes of inflammatory bowel disease, on health-care utilisation and patient-reported quality of care versus standard care.METHODS: We did this pragmatic, randomised trial in two academic and two non-academic hospitals in the Netherlands. Outpatients aged 18-75 years with inflammatory bowel disease and without an ileoanal or ileorectal pouch anastomosis, who had internet access and Dutch proficiency, were randomly assigned (1:1) to care via a telemedicine system (myIBDcoach) that monitors and registers disease activity or standard care and followed up for 12 months. Randomisation was done with a computer-generated sequence and used the minimisation method. Participants, health-care providers, and staff who assessed outcome measures were not masked to treatment allocation. Primary outcomes were the number of outpatient visits and patient-reported quality of care (assessed by visual analogue scale score 0-10). Safety endpoints were the numbers of flares, corticosteroid courses, hospital admissions, emergency visits, and surgeries. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02173002.FINDINGS: Between Sept 9, 2014, and May 18, 2015, 909 patients were randomly assigned to telemedicine (n=465) or standard care (n=444). At 12 months, the mean number of outpatient visits to the gastroenterologist or nurse was significantly lower in the telemedicine group (1·55 [SD 1·50]) than in the standard care group (2·34 [1·64]; difference -0·79 [95% CI -0·98 to -0·59]; p<0·0001), as was the mean number of hospital admissions (0·05 [0·28] vs 0·10 [0·43]; difference -0·05 [-0·10 to 0·00]; p=0·046). At 12 months, both groups reported high mean patient-reported quality of care scores (8·16 [1·37] in the telemedicine group vs 8·27 [1·28] in the standard care group; difference 0·10 [-0·13 to 0·32]; p=0·411). The mean numbers of flares, corticosteroid courses, emergency visits, and surgeries did not differ between groups.INTERPRETATION: Telemedicine was safe and reduced outpatient visits and hospital admissions compared with standard care. This self-management tool might be useful for reorganising care of inflammatory bowel disease towards personalised and value-based health care.FUNDING: Maastricht University Medical Centre and Ferring.

AB - BACKGROUND: Tight and personalised control of inflammatory bowel disease in a traditional setting is challenging because of the disease complexity, high pressure on outpatient clinics, and rising incidence. We compared the effects of self-management with a telemedicine system, which was developed for all subtypes of inflammatory bowel disease, on health-care utilisation and patient-reported quality of care versus standard care.METHODS: We did this pragmatic, randomised trial in two academic and two non-academic hospitals in the Netherlands. Outpatients aged 18-75 years with inflammatory bowel disease and without an ileoanal or ileorectal pouch anastomosis, who had internet access and Dutch proficiency, were randomly assigned (1:1) to care via a telemedicine system (myIBDcoach) that monitors and registers disease activity or standard care and followed up for 12 months. Randomisation was done with a computer-generated sequence and used the minimisation method. Participants, health-care providers, and staff who assessed outcome measures were not masked to treatment allocation. Primary outcomes were the number of outpatient visits and patient-reported quality of care (assessed by visual analogue scale score 0-10). Safety endpoints were the numbers of flares, corticosteroid courses, hospital admissions, emergency visits, and surgeries. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02173002.FINDINGS: Between Sept 9, 2014, and May 18, 2015, 909 patients were randomly assigned to telemedicine (n=465) or standard care (n=444). At 12 months, the mean number of outpatient visits to the gastroenterologist or nurse was significantly lower in the telemedicine group (1·55 [SD 1·50]) than in the standard care group (2·34 [1·64]; difference -0·79 [95% CI -0·98 to -0·59]; p<0·0001), as was the mean number of hospital admissions (0·05 [0·28] vs 0·10 [0·43]; difference -0·05 [-0·10 to 0·00]; p=0·046). At 12 months, both groups reported high mean patient-reported quality of care scores (8·16 [1·37] in the telemedicine group vs 8·27 [1·28] in the standard care group; difference 0·10 [-0·13 to 0·32]; p=0·411). The mean numbers of flares, corticosteroid courses, emergency visits, and surgeries did not differ between groups.INTERPRETATION: Telemedicine was safe and reduced outpatient visits and hospital admissions compared with standard care. This self-management tool might be useful for reorganising care of inflammatory bowel disease towards personalised and value-based health care.FUNDING: Maastricht University Medical Centre and Ferring.

KW - Journal Article

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DO - 10.1016/S0140-6736(17)31327-2

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VL - 390

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JO - Lancet

JF - Lancet

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