Inflammatory Bowel Disease Telemedicine Clinical Trial: Impact of Educational Text Messages on Disease-Specific Knowledge Over 1 Year

Abutaleb A1, Buchwald A1, Chudy-Onwugaje K1, Langenberg P1, Regueiro M2, Schwartz DA3, Tracy JK1, Ghazi L4, Patil SA1, Quezada SM1, Russman KM1, Quinn CC1, Jambaulikar G5, Beaulieu DB3, Horst S3, Cross RK1. Inflamm Bowel Dis. 2018 May 18. doi: 10.1093/ibd/izy149. [Epub ahead of print]

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1 University of Maryland School of Medicine, Baltimore, Maryland.

2 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

3 Vanderbilt University School of Medicine, Nashville, Tennessee.

4 Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

5 Brigham and Women's Hospital, Boston, Massachusetts.


BACKGROUND: Effective treatments are available for patients with inflammatory bowel disease (IBD); however, suboptimal outcomes occur and are often linked to patients' limited disease knowledge. The aim of this analysis was to determine if delivery of educational messages through a telemedicine system improves IBD knowledge.

METHODS: TELEmedicine for Patients with IBD (TELE-IBD) was a randomized controlled trial with visits at baseline, 6 months, and 12 months; patient knowledge was a secondary aim of the study. Patients were randomized to receive TELE-IBD every other week (EOW), weekly (TELE-IBD W), or standard of care. Knowledge was assessed at each visit with the Crohn's and Colitis Knowledge (CCKNOW) survey. The primary outcome was change in CCKNOW score over 1 year compared between the TELE-IBD and control groups.

RESULTS: This analysis included 219 participants. Participants in the TELE-IBD arms had a greater improvement in CCKNOW score compared with standard care (TELE-IBD EOW +2.4 vs standard care +1.8, P = 0.03; TELE-IBD W +2.0 vs standard care +1.8, P = 0.35). Participants with lower baseline CCKNOW scores had a greater change in their score over time (P < 0.01). However, after adjusting for race, site, and baseline knowledge, there was no difference in CCKNOW score change between the control and telemedicine arms.

CONCLUSIONS: Telemedicine improves IBD-specific knowledge through text messaging, although the improvement is not additive with greater frequency of text messages. However, after adjustment for confounding variables, telemedicine is not superior to education given through standard visits at referral centers. Further research is needed to determine if revised systems with different modes of delivery and/or frequency of messages improve disease knowledge.

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