SELECTED SUMMARIES

Where We’re Going, We Don’t Need Appointments:The Future of Telemedicine in IBD

Krier M, Kaltenbach T, McQuaid K, et al. Potential use of telemedicine to provide outpatient care forinflammatory bowel disease. Am J Gastroenterol. 2011;106:2063–2067.

T elemedicine has been shown to enhance access to care

and to improve monitoring, education, and adherence.

Telemedicine includes teleconferencing, teleconsults,

remote visits, and telemonitoring. Telemedicine could

serve an important role in the care of patients with

inflammatory bowel disease (IBD), as medical therapies

require close monitoring and adherence, coordination

among multiple medical and surgical disciplines, and

maintenance of a strong alliance between the patient and

provider.

Krier et al1 developed a telemedicine system to

facilitate access to specialized care for veterans with

IBD. Veterans were seen by a gastroenterology fellow

at the Palo Alto, California Veterans Administration

(VA) for a face-to-face visit. The fellow then went to a

work station where they consulted with an IBD special-

ist at the San Francisco VA. If needed, real-time con-

sultation with either a pathologist or radiologist could

be incorporated into the session. The fellow then

resumed contact with the veteran, at which time the

IBD specialist was accessed remotely via videoconfer-

encing for counseling and education in the examination

room. Thirty-four veterans were assigned by a ward

secretary to undergo either a routine visit (n ¼ 19) or a

telemedicine encounter (n ¼ 15) based on the week of

the month of the visit. Overall, the Veterans were older

and mostly Caucasian. Crossover was allowed in fol-

low-up depending on the availability of clinic visits.

Fifty-nine visits were conducted over 9 months. The

primary outcome was patient satisfaction using the

Ware Specific Visit Questionnaire. Veterans expressed

satisfaction with the telemedicine encounter, assigning

equivalent ratings to the standard clinical encounter in

bedside manner, attention to patient concerns, and per-

ceived skill of the doctor. Visit duration, wait times,

and median clinic visits were similar between the tele-

medicine and standard care groups. The average visit

took �1 hour and the number of visits per session was

between four and five.1 This proof-of-concept study

demonstrates that telemedicine can be used for provider

and patient access to a provider with expertise in IBD

care. Patient satisfaction with the experience is no dif-

ferent than with a standard clinical encounter and dura-

tion of clinic visits, cycle times, and number of clinic

visits per session is not affected by the ‘‘mode’’ of the

visit. The results, although encouraging, should be

viewed with caution, as the patient population was an

older, male, Caucasian Veteran population. Further, the

clinic visits were longer and the number of patients

seen was fewer than in clinical practice. Overall, the

results support development of telemedicine technology

to improve access to specialty IBD care.

Telemonitoring in IBD has been explored in prior

studies. Use of a home telemanagement system (IBD

HAT) was developed by our group to allow for assess-

ment and monitoring of bowel symptoms, adherence to

medications, side effects of therapy, body weight, and

to provide an educational platform to improve disease

knowledge.2 In a follow-up 6-month quasi-experimental

study, patients were able to successfully utilize IBD

HAT with excellent adherence and greater satisfaction

with their care. In addition, IBD HAT improved disease

activity, quality of life, and IBD knowledge.3,4 In a

randomized, controlled study including ulcerative colitis

(UC) patients exclusively (UC HAT), weekly use of UC

HAT was associated with a significant decrease in dis-

ease activity as measured by the Seo index, and a sig-

nificant increase in quality of life as measured by the

Inflammatory Bowel Disease Questionnaire.5 A web-

based system, such as the one employed by Elkajer et

al6 in a 2010 study may further increase ease of use.

Patients with mild to moderate UC (n ¼ 333) from Ire-

land and Denmark were randomized to either a web

group (disease-specific education and self-treatment) or

a control group (standard care) for 1 year. The web

group experienced improved adherence to short-term

treatment, increased IBD knowledge and quality of life,

shorter median duration of relapse, and decreased num-

ber of acute care visits.7

DOI 10.1002/ibd.23014

Published online in Wiley Online Library

(wileyonlinelibrary.com).

Received for publication April 10, 2012; Accepted April 22, 2012.

Copyright VC 2012 Crohn’s & Colitis Foundation of America, Inc.

Inflamm Bowel Dis 1

Telemedicine is a novel tool with many potential

uses in the care of patients with IBD. As the therapeu-

tic options for IBD continue to increase, evaluation and

close monitoring by specialized IBD providers will

become increasingly important. Telemonitoring is one

technique that can be implemented to enhance monitor-

ing of disease activity and toxicity of therapy, improve

adherence, encourage self-treatment, and augment

patient education. Telemedicine may also increase

access to specialty IBD care in patients with limited

access to referral centers. In addition, telemedicine may

be used for ‘‘at-risk’’ patients, including younger

patients, patients with a history of nonadherence, and

those with limited social support. A secure web-based

system is likely the most efficient and user-friendly

platform to deliver telemedicine in IBD, and compatibil-

ity with hand-held mobile devices will further improve

ease of use. Inadequate reimbursement of telemedicine

services may limit widespread adoption of this technol-

ogy. However, the study by Krier et al and others are

proof of concept that telemedicine in IBD has the

potential to be an important addition to IBD manage-

ment in the future.

Seema Patil, MDRaymond Cross, MD, MS

Department of Medicine

Division of Gastroenterology and Hepatology

University of Maryland

Baltimore, Maryland

REFERENCES1. Krier M, Kaltenbach T, McQuaid K, et al. Potential use of telemedicine

to provide outpatient care for inflammatory bowel disease. Am J Gas-troenterol. 2011;106:2063–2067.

2. Cross RK, Arora M, Finkelstein J. Acceptance of telemanagement ishigh in patients with inflammatory bowel disease. J Clin Gastroenterol.2006;40:200–208.

3. Cross RK, Finkelstein J. Feasibility and acceptance of a home telema-nagement system in patients with inflammatory bowel disease: a 6-month pilot study. Dig Dis Sci. 2007;52:357–364.

4. Cross RK, Cheevers N, Finkelstein J. Home telemanagement for patientswith ulcerative colitis (UC HAT). Dig Dis Sci. 2009;54:2463–2472.

5. Cross RK, Cheevers, N, et al. A randomized, controlled trial of hometelemanagement in patients with ulcerative colitis (UC HAT). In: Pro-ceedings of American Gastroenterological Association Digestive Dis-eases Week, May 2011, Chicago, IL.

6. Elkjaer, M, Burisch et al. Development of a web-based concept forpatients with ulcerative colitis and 5-aminosalicylic acid treatment. EurJ Gastroenterol Hepatol. 2010;22:695–704.

7. Elkjaer M, Shuhaibar M, Burisch J, et al. E-health empowers patientswith ulcerative colitis: a randomised controlled trial of the web-guided‘Constant-care’ approach. Gut. 2010;59:1652–1661.

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