SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Frédéric CORDET
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2018/11  
 
  2018 Nov.  
  doi: 10.1038/s41395-018-0272-8.  
 
  A Randomized Controlled Trial of TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD)  
 
  Cross RK, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Collins JF, Katz J, Ghazi L, Patil SA, Quezada SM, Beaulieu D, Horst SN, Russman K, Riaz M, Jambaulikar G, Sivasailam B, Quinn CC  
  https://www.ncbi.nlm.nih.gov/pubmed/30410041  
 
 

bstract

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 versus 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 health care 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. Health care 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.

 

 
Question posée
 
Etude randomisée comparant les résultats d’une prise en charge standard et d’un suivi en télémédecine de patients MICI.
 
Question posée
 
Le groupe suivi en télémédecine présente moins d’hospitalisation et plus de recours aux tests non-invasifs pour les même résultats en terme d’évolution de la pathologie et de qualité de vie.
 
Commentaires

A l’heure du passage de la télémédecine et notamment de la téléconsultation dans le droit commun, cette étude confirme que le suivi des patients MICI par télémédecine fait aussi bien qu’un suivi habituel en consultation, voire mieux en terme d’hospitalisation pour motifs liés ou pas à la pathologie inflammatoire. Et améliore l’investissement du patient dans la gestion de sa pathologie. Cette nouvelle modalité peut donc progressivement s’intégrer à nos pratiques, notamment pour les patients éloignés ou moins disponibles pour des raisons professionnelles.

 
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