A Randomized Controlled Trial of TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD)
A Randomized Controlled Trial of TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD)
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DOI：
10.1038/s41395-018-0272-8
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发表时间：
2019-03-01
影响因子：
9.8
通讯作者：
Quinn, Charlene C.
中科院分区：
文献类型：
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作者：
Cross, Raymond K.;Langenberg, Patricia;Quinn, Charlene C.
引言：远程医疗在炎症性肠病（IBD）中显示出了希望。本研究的目的是比较疾病的活动和生活质量（QoL）在1年的随机试验IBD患者接受远程医疗与标准care.METHODS：在过去2年症状恶化的患者有资格随机远程医疗（通过文本EOW或每周监测）或标准护理。主要结果是在疾病活动和生活质量的变化组之间的差异;组间的医疗保健利用的变化是次要aims.RESULTS：348名参与者（117对照组，115 TELE-IBD EOW，和116 TELE-IBD每周）。259例（74.4%）完成研究。年龄为38.9 ± 12.3岁，56.6%为女性，91.9%为高加索人，67.9%患有克罗恩病（CD），42.5%在基线时患有活动性疾病。在CD中，所有组均经历了疾病活动度的降低，（对照组-5.2 +/-5.0至3.7 +/-3.6，TELE-IBD EOW 4.7 +/-4.1至4.2 +/-3.9，和TELE-IBD每周4.2 +/-4.2至3.2 +/-3.4，每组p < 0.0001）在UC中，只有对照组的疾病活动性显著降低，（对照组2.9 +/- 3.1至1.4 +/- 1.4，p = 0.01，TELE-IBD EOW 2.7 +/- 3.1至1.7 +/- 1.9，p = 0.35，和TELE-IBD每周2.5 +/- 2.5至2.0 +/- 1.8，p = 0.31）。各组生活质量均增加;仅在TELE-IBD EOW中增加显著（对照组168.1 +/- 34.0至179.3 +/- 28.2，p = 0.06，TELE-IBD EOW 172.3 +/- 33.1至181.5 +/- 28.2，p = 0.03，和TELE-IBD每周172.3 +/- 34.5至179.2 +/- 32.8，p = 0.10）。未经调整和调整的疾病活动和生活质量的变化没有显着差异组。所有群体的医疗保健利用率都有所增加。TELE-IBD每周都不太可能有IBD相关的住院治疗，更有可能有非侵入性诊断测试和电子接触相比，控制;两个TELE-IBD组减少了非IBD相关的住院治疗和增加电话controls.Discussion：疾病活动和生活质量，虽然在所有参与者改善，并没有通过使用TELE-IBD系统进一步改善。远程IBD参与者的住院次数减少，而非侵入性诊断测试、电话和电子接触的次数相应增加。需要进行研究以确定是否可以通过患者参与来改善TELE-IBD，以及是否可以通过取代标准护理来降低医疗保健利用率。
INTRODUCTION:Telemedicine has shown promise in inflammatory bowel disease (IBD). The objective of this study was to compare disease activity and quality of life (QoL) in a 1-year randomized trial of IBD patients receiving telemedicine vs. standard care.METHODS:Patients with worsening symptoms in the prior 2 years were eligible for randomization to telemedicine (monitoring via texts EOW or weekly) or standard care. The primary outcomes were the differences in change in disease activity and QoL between the groups; change in healthcare utilization among groups was a secondary aim.RESULTS:348 participants were enrolled (117 control group, 115 TELE-IBD EOW, and 116 TELE-IBD weekly). 259 (74.4%) completed the study. Age was 38.9 12.3 years, 56.6% were women, 91.9% were Caucasian, 67.9% had Crohn's disease (CD) and 42.5% had active disease at baseline. In CD, all groups experienced a decrease in disease activity (control -5.2 +/- 5.0 to 3.7 +/- 3.6, TELE-IBD EOW 4.7 +/- 4.1 to 4.2 +/- 3.9, and TELE-IBD weekly 4.2 +/- 4.2 to 3.2 +/- 3.4, p < 0.0001 for each of the groups) In UC, only controls had a significant decrease in disease activity (control 2.9 +/- 3.1 to 1.4 +/- 1.4, p = 0.01, TELE-IBD EOW 2.7 +/- 3.1 to 1.7 +/- 1.9, p = 0.35, and TELE-IBD Weekly 2.5 +/- 2.5 to 2.0 +/- 1.8, p = 0.31). QoL increased in all groups; the increase was significant only in TELE-IBD EOW (control 168.1 +/- 34.0 to 179.3 +/- 28.2, p = 0.06, TELE-IBD EOW 172.3 +/- 33.1 to 181.5 +/- 28.2, p = 0.03, and TELE-IBD Weekly 172.3 +/- 34.5 to 179.2 +/- 32.8, p = 0.10). Unadjusted and adjusted changes in disease activity and QoL were not significantly different among groups. Healthcare utilization increased in all groups. TELE-IBD weekly were less likely to have IBD-related hospitalizations and more likely to have non-invasive diagnostic tests and electronic encounters compared to controls; both TELE-IBD groups had decreased non-IBD related hospitalizations and increased telephone calls compared to controls.DISCUSSION:Disease activity and QoL, although improved in all participants, were not improved further through use of the TELE-IBD system. TELE-IBD participants experienced a decrease in hospitalizations with an associated increase in non-invasive diagnostic tests, telephone calls and electronic encounters. Research is needed to determine if TELE-IBD can be improved through patient engagement and whether it can decrease healthcare utilization by replacing standard care.