Demographic and Clinical Predictors of Adherence to Self-testing in Telemedicine for Patients With Inflammatory Bowel Disease (TELE-IBD)

Abstract

Introduction: Telemedicine is increasingly utilized in the care of patients with inflammatory bowel disease (IBD). However, telemedicine requires active patient engagement as symptom monitoring, self-assessment and periodic reporting are needed for optimal health outcomes. Our aim was to identify the socio-demographic and clinical predictors of adherence to self-testing in patients with IBD enrolled in the Telemedicine for Patients with IBD (TELE-IBD) study. Methods: This was a prospective cohort study of participants in the 2 intervention arms of the TELE-IBD study. Data were collected at baseline and participants received adjunctive care with TELE-IBD for 1 year. Depending on group assignment, weekly or every other week (EOW) messages were sent to participants to initiate self-testing sessions. During the sessions, participants were prompted to respond to a series of simple text messages regarding disease symptoms, medication side-effects, and body weight. Based on responses, an assessment of disease severity and action plans were generated and communicated via text. Adherence was defined as completion of ≥80% of self-testing sessions at the end of the study period. Multivariate logistic regression were used to assess predictors of adherence. Results: Among 191 total participants, mean age was 39.2 +/- 12.4 years, 56% were women, and 94% were Caucasian. 127 (66%) had Crohn's disease (CD) and mean disease duration was 12.5 +/- 9.0 years. 110 (58%) were adherent to self-testing. In bivariate analysis for those with CD, female gender (P=0.005), Crohn's and Colitis Knowledge (CCKNOW) score > 14 (P= 0.037), perforating disease (P= 0.047), c reactive protein (CRP) >3 (P= 0.043) and perianal involvement (P= 0.05) were associated with adherence. For those with ulcerative colitis (UC), a history of immune suppressant use (P= 0.05) and testing EOW (P= 0.009) were associated with adherence. On multivariate analysis in CD, female gender (OR 2.59, 95% CI 1.05-6.36, p= 0.03) and CRP > 3 (OR 2.97, 95% CI 1.16-7.58, p= 0.02) remained independently associated with adherence while testing EOW (OR 3.32, 95% CI 1.11-9.89) was a significant predictor in UC. Conclusion: Female gender and inflammatory disease activity in CD, and testing EOW in UC are significant predictors of adherence to self-testing. This suggests a role for targeted selection of IBD patients for participation in telemedicine to improve adherence and patient engagement.Table: Table. Baseline Demographic, Clinical and Psychosocial Characteristics of Study Population by Inflammatory Bowel Disease Type