Efficacy of Home Telemonitoring versus Conventional Follow-up: A Randomized Controlled Trial among Teenagers with Inflammatory Bowel Disease
Efficacy of Home Telemonitoring versus Conventional Follow-up: A Randomized Controlled Trial among Teenagers with Inflammatory Bowel Disease
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DOI：
10.1093/ecco-jcc/jjx169
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发表时间：
2018-04-01
影响因子：
8
通讯作者：
van Rheenen, Patrick F.
中科院分区：
文献类型：
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作者：
Heida, Anke;Dijkstra, Alie;van Rheenen, Patrick F.
背景和目标：对患有炎症性肠病（IBD）的青少年的常规随访是在预定的门诊访视期间进行的，无论患者感觉如何。我们设计了一个远程监测策略，早期识别耀斑和比较其疗效与传统follow-up.Methods：我们使用了一个多中心随机试验，年龄在10-19岁的IBD患者在基线临床缓解。被分配到远程监测的参与者收到自动警报，以完成症状评分并发送粪便样本用于测量钙卫蛋白。这导致了对发作的个体预测以及相关的治疗建议和检测间隔。在常规随访中，健康检查间隔由医生自行决定。主要终点是疾病发作的累积发生率。次要终点是参与者的百分比与积极的变化，生活质量和成本效益的intervention.Results：我们包括170名参与者[84远程监护; 86传统的后续行动]。第52周时，远程监护组的平均面对面访视次数显著低于传统随访[3.6 vs 4.3，p < 0.001]。发作的发生率[33 vs 34%，p = 0.93]和报告生活质量积极变化的参与者比例[54 vs 44%，p = 0.27]相似。平均每年节省成本（原文如此）89，增加到（原文如此）360在那些符合protocol.Conclusions：远程监护是安全的，传统的后续行动，并减少门诊就诊和社会成本。对生活质量的积极影响在两组中相似。这种策略对青少年和家庭很有吸引力，卫生专业人员可能有兴趣使用它来保持青少年远离医院，减轻过度紧张的门诊服务的压力。
Background and Aims: Conventional follow-up of teenagers with inflammatory bowel diseases [IBD] is done during scheduled outpatient visits regardless of how well the patient feels. We designed a telemonitoring strategy for early recognition of flares and compared its efficacy with conventional follow-up.Methods: We used a multicentre randomized trial in patients aged 10-19 years with IBD in clinical remission at baseline. Participants assigned to telemonitoring received automated alerts to complete a symptom score and send a stool sample for measurement of calprotectin. This resulted in an individual prediction for flare with associated treatment advice and test interval. In conventional follow-up the health check interval was left to the physician's discretion. The primary endpoint was cumulative incidence of disease flares. Secondary endpoints were percentage of participants with a positive change in quality-of-life and cost-effectiveness of the intervention.Results: We included 170 participants [84 telemonitoring; 86 conventional follow-up]. At 52 weeks the mean number of face-to-face visits was significantly lower in the telemonitoring group compared to conventional follow-up [3.6 vs 4.3, p < 0.001]. The incidence of flares [33 vs 34%, p = 0.93] and the proportion of participants reporting positive change in quality-of-life [54 vs 44%, p = 0.27] were similar. Mean annual cost-saving was (sic)89 and increased to (sic)360 in those compliant to the protocol.Conclusions: Telemonitoring is as safe as conventional follow-up, and reduces outpatient visits and societal costs. The positive impact on quality-of-life was similar in the two groups. This strategy is attractive for teenagers and families, and health professionals may be interested in using it to keep teenagers who are well out of hospital and ease pressure on overstretched outpatient services.