Abstract

The efficacy of home telemonitoring versus conventional follow-up: a randomised controlled trial among teenagers with inflammatory bowel disease

Heida A1, Dijkstra A1, Muller Kobold A2, Rossen J3, Kindermann A4, Kokke F5, de Meij T6, Norbruis O7, Weersma R8, Wessels M9, Hummel T10, Escher H11, van Wering H12, Hendriks D13, Mearin L14, Groen H15, Verkade H1, van Rheenen P1. J Crohns Colitis. 2017 Dec 8. doi: 10.1093/ecco-jcc/jjx169. [Epub ahead of print]
 
     
Author information

1 Paediatric Gastroenterology, Hepatology and Nutrition, Department of paediatrics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

2 Department of Laboratory Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

3 Department of Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

4 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Emma Children's hospital Academic Medical Centre, Amsterdam, The Netherlands.

5 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Wilhelmina Children's Hospital, Utrecht, The Netherlands.

6 Department of Paediatric Gastroenterology, Hepatology and Nutrition, VU Medical Centre, Amsterdam, The Netherlands.

7 Department of Paediatrics, Isala clinic, Zwolle, The Netherlands.

8 Department of Gastroenterology and Hepatology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

9 Department of Paediatrics, Rijnstate Hospital, Arnhem, The Netherlands.

10 Department of Paediatrics, Medisch Spectrum Twente, Enschede, The Netherlands.

11 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.

12 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Amphia Hospital, Breda, The Netherlands.

13 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Haga Hospital, The Hague, The Netherlands.

14 Department of Paediatric Gastroenterology, Hepatology and Nutrition, Leiden University Medical Centre, Leiden, The Netherlands.

15 Department of epidemiology, University of Groningen, University Medical Centre Groningen, The Netherlands.

Abstract

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: Multicentre randomised 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 calprotectin measurement. 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. 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 versus 4.3, P<0.001). The incidence of flares (33 versus 34%, P= 0.93) and the proportion of participants reporting positive change in quality-of-life (54% versus 44%, P=0.27) were similar. Mean annual cost-saving was €89 and increased to €360 in those compliant to the protocol.

CONCLUSIONS: Telemonitoring is as safe as conventional follow-up, reduces outpatient visits and societal costs. The positive impact on quality-of-life was similar in both 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.

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