E‐Health and remote management of patients with inflammatory bowel disease: lessons from Denmark in a time of need

Abstract

In Denmark, remote monitoring and management of inflammatory bowel disease (IBD) started two decades ago with the web application Constant Care. The disease monitoring in Constant Care consists of simple disease activity questionnaires and home measurement of faecal calprotectin, a stool biomarker for inflammation. It has now been implemented in clinical practice at North Zealand University Hospital in Denmark. Digital health care solutions facilitate remote contact between patients and healthcare providers and have been shown to reduce time to remission, outpatient visits and hospital admissions, and increase adherence to medical therapy, quality of life and disease and treatment knowledge. In Australia, E‐Health is an area of increasing interest, particularly given the significant distances travelled by rural patients to access specialist care. There are several foreseeable benefits to incorporating E‐Health/remote monitoring into Australian IBD management, including reduced burdens of time and cost on rural patients, and more efficient management of well outpatients, thereby increasing clinic availability for acutely unwell patients. The significant portion of IBD patients managed in private practice in Australia, and the infrastructure within private practice that is well suited to implementation of E‐Health makes Australia a viable setting for an E‐Health IBD management model like Denmark's Constant Care model. One pilot study is currently underway investigating the feasibility of rapid and remote IBD monitoring and E‐Health in an Australian IBD population. The current COVID‐19 pandemic has further illustrated the importance of telehealth as a means of maintaining health services to patients in geographic, or social, isolation.

Video capsule endoscopy in patients with iron deficiency anaemia: experience at a regional Australian service

“…Differences between study criteria determining positive findings outside the small bowel likely accounts for some of this variability, however the high rate of “missed lesions” highlights the importance of the initial endoscopic assessment. This is particularly relevant for rural patients who encounter increased logistical and financial barriers to pursuing specialist services such as VCE [ 10 ]. The results of this study may support the claim for second look endoscopy prior to VCE suggested by others [ 16 , 17 ].…”

“…Appropriate patient selection for VCE has particular importance in a regional setting given the impact which rurality has on access to specialist healthcare. The vast distances between Australian rural towns and major cities and the concentration of specialists in urban centres constitute major barriers to access for regional patients [ 9 , 10 ]. Given that VCE is neither widely available nor readily accessible in a regional setting, ideal selection of patients is imperative.…”

A Digital Health Intervention to Improve the Clinical Care of Inflammatory Bowel Disease Patients

“…3,4 We have already begun to see the success of remote patient monitoring technologies as well as how the need for them has grown with the coronavirus disease 2019 pandemic. 5,6 For the IBD population, at least a dozen applications on education, symptom monitoring, and quality of life improvement have been created and studied. 3 The HealthPROMISE smartphone application developed at the Icahn School of Medicine in Mount Sinai led to a 22% reduction in hospitalizations after utilization of the application among its 32 patients when compared with the year prior.…”

IBD barriers across the continents: a continent-specific analysis – Australasia

“…The problems are compounded if the patient is complex and requires specialised investigations such as magnetic resonance imaging and colonoscopy. Ankersen et al 64…”

“…Telemedicine and the various digital platforms of providing remote healthcare have been effective in delivering healthcare for a variety of medical conditions, including IBD. 64 For many regional and remote patients, attendance in-person medical appointments require long travel times, significant finances and access to a vehicle. Public transportation is not always available for these appointments, and some areas require transport by boat or by plane.…”