Telemedicine monitoring failed to increase inflammatory bowel disease patients’ confidence or motivation to manage their status, compared to standard routine care, a study reported.
The study, “Effect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy,” was published in Digestive Diseases and Sciences.
Inflammatory bowel disease (IBD) comprises a group of autoimmune disorders, including Crohn’s disease (CD) and ulcerative colitis (UC), that cause inflammation of the gastrointestinal (GI) tract. IBD incidence has been steadily increasing over the past few years and is now estimated to affect around 1.6 million adults in the U.S.
“While treatment exists for IBD, a number of factors reduce the efficacy of IBD care. These include but are not limited to heterogeneity of phenotypes [symptoms shown] resulting in wide variation in care, low patient adherence to medications, costs of and access to treatment, low patient knowledge of IBD, and inadequate monitoring of side effects,” the researchers said.
For this reason, implementing strategies designed to improve IBD patients’ self-care are extremely important. Telemedicine could be one such approach.
“Telemedicine enables providers to monitor, treat, educate, and support IBD patients managing their symptoms, possibly increasing patients’ involvement in their own care and confidence in their ability to perform self-care,” the investigators said.
In this study, a team of researchers from the University of Maryland School of Medicine in Baltimore carried out a clinical trial to assess how telemedicine improves IBD patients’ self-efficacy or activation compared to conventional care.
The one-year, multicenter, randomized, controlled, Phase 3 TELEmedicine for Patients with IBD (TELE-IBD) trial (NCT01692743) enrolled 348 adult IBD patients who experienced disease flare-ups over the last two years before enrolling in the study.
Patients were randomly divided into three groups: the control group receiving standard care (SC, 117 patients); the group testing the TELE-IBD system (a web-based system that allows patient monitoring and interaction with clinicians through text messages) every other week (EOW, 115 patients); and the group testing the TELE-IBD system weekly (W, 116 patients).
Self-efficacy — patients’ confidence to overcome obstacles and achieve a goal — was measured by the General Self-Efficacy Scale (GSE). Patients’ activation — knowledge, skills,
and motivation to effectively manage their health status — was determined using the 13-item Patient Activation Measure (PAM).
From the 348 IBD patients initially enrolled, only 187 who completed the GSE and PAM questionnaires at baseline and one year after the beginning of the study were included in the analysis.
All groups showed mild improvements in GSE. However, none of the intervention groups showed significant improvements compared to the control group. On the other hand, PAM scores were significantly higher in the SC and TELE-IBD W groups, compared to the TELE-IBD EOW group.
Moreover, researchers found that IBD patients with lower baseline GSE and PAM scores showed greater improvement in self-efficacy and activation over the course of the study.
“Overall, use of remote monitoring through text messaging as an adjunct to care did not improve GSE or PAM compared to routine care in referral centers for IBD,” the researchers stated. “Further research is needed to elucidate factors that increase self-efficacy and patient activation among IBD patients, including whether targeted intervention with telemedicine in high-risk groups is more effective than standard care.”
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