Randomized, controlled trial of home telemanagement in patients with ulcerative colitis (UC HAT)*

Abstract

Introduction Outcomes are suboptimal in ulcerative colitis (UC). Telemedicine for UC is feasible and improves outcomes. Our goals were to evaluate a home telemanagement system for UC (UC HAT) on disease activity, quality of life (QoL), and adherence compared to best available care (BAC) in a randomized, controlled trial. Materials and Methods Adults with UC were randomly assigned to receive UC HAT or BAC for 12 months. UC HAT recruits answered questions regarding disease activity, adherence, side effects, and measured their weight weekly. An educational curriculum was delivered after each session. Alerts and action plans were generated based on the results. BAC underwent routine follow up, received written action plans and were given educational fact sheets. Seo Index scores, IBDQ scores, and adherence rates were compared between UC HAT and BAC at one year. Results 25 patients were randomized to UC HAT and 22 to BAC. After 12 months, 11 withdrew in UC HAT compared to 5 in BAC. Disease activity, QoL, and adherence were not different between groups at any time point post baseline. Adjusted analyses of trial completers using all available data, demonstrated decreased Seo index (11.9 in UC HAT (p=0.08) vs. 1.2 in BAC (p=0.84) and increased IBDQ scores (12.5 in UC HAT (p=0.04) vs. to −3.8 in BAC (p=0.47) from baseline in UC HAT compared to BAC. Discussion UC HAT did not improve disease activity, QoL or adherence compared to BAC after 1 year. After adjustment for baseline disease knowledge, UC HAT trial completers experienced significant gains in disease-specific quality of life from baseline compared to BAC trial completers. Our results suggest a potential benefit of UC HAT. Further research is indicated to determine if telemedicine improves outcomes in patients with IBD.

Practical Strategies for Enhancing Adherence to Treatment Regimen in Inflammatory Bowel Disease

“…Interventions in adults with UC that have included individual interaction with health care professionals as 1 part of a multicomponent intervention suggest this as a promising approach. 25–27 Additionally, descriptive research corroborates the importance of the patient–provider relationship in suggesting that nonadherence is more frequent when there is discordance between patient and physician, a phenomenon documented among adults with IBD 35 and other illness groups. 36,37 In contrast, specific provider behaviors that may enhance adherence include a collaborative style of interaction, open discussion of the patient’s level of knowledge about their regimen, and discussion about the patient’s beliefs about the acceptability and necessity of the medication, concerns related to taking medication, and perceived impact of IBD on their functioning.…”

“…Additionally, Cross and colleagues developed the UC HAT program for adults with UC. 26,27 Their results documented higher adherence to those in the intervention group at 12 months after intervention relative to a control group; however, there were no differences between intervention and control groups at 4 or 8 months after intervention. Intervention components included patient education, individualized and automated feedback on patient symptoms, and follow-up phone contact with nurses to alter the medication regimen when clinically indicated based on symptom profiles.…”

“…Evidence exists to support that multicomponent interventions can enhance adherence in adults with UC on 5-ASAs 25–27 and in youth with IBD on thiopurines and aminosalycilates. 28,29 …”

Application of Telemedicine for Patients with Inflammatory Bowel Disease: Review of the Literature and Future Implications

“…Adherence was low in both groups at baseline, but improved in both groups over 12 months. No significant differences in adherence were noted between groups [19].…”

Psychological Considerations and Interventions in Inflammatory Bowel Disease Patient Care

“…Four studies on web-based interventions exist for IBD 76 . The existing literature is promising, suggesting improved outcomes in IBD with use of these interventions 77, 78 . Web-based psychological interventions are effective in treating depression and anxiety 79–81 , insomnia 82 , and irritable bowel syndrome 83, 84 .…”