P301 Effects of telemonitoring on safety and health care costs with a web platform (TECCU) in complex IBD patients: A randomised controlled trial

Abstract

The use of telemedicine enables continuous and tailored control of chronically ill patients, potentially providing a solution to the medical, social and financial impact of inflammatory bowel disease (IBD). Safety of a web telemanagement system designed for complex IBD patients, TECCU (Telemonitorización de la Enfermedad de Crohn y Colitis Ulcerosa [Telemonitoring of Crohn’s disease and ulcerative colitis]) and its impact on healthcare utilisation, compared with standard care (G_Control) and nurse-assisted telephone care (G_NT) were evaluated. A 3-arm randomised clinical trial was performed in an academic hospital in Spain. IBD patients aged ≥18 years who initiated therapy with corticosteroids, immunomodulators, and/or biological agents for disease activity were consecutively included. Exclusion criteria were: patients with ileorectal/ileo-pouch anal anastomosis, no Internet access and inability to communicate properly in Spanish. Eligible participants were randomised to receive remote monitoring (G_TECCU), G_NT or G_control for 24 weeks in a 1:1:1 ratio using a web-based program. TECCU is a secured webpage with an HTTPS application for smartphone, tablet and computer. Healthcare resources were measured including the number of outpatient visits and telephone calls attended by healthcare providers. Safety was defined in terms of emergency visits, corticosteroid courses, hospitalisations, and IBD-related surgeries. In addition, the cost of each procedure was assessed using official prices of each health service. 63 patients were included and 21 were randomly assigned to each group. Most patients had CD—14 (66.7%) in G_control, 13 (61.9%) in G_NT, and 13 (61.9%) in G_TECCU. The median of disease progression was 146.7 months (range 7–424) in G_TECCU, 123.3 (6-427) in G_control and 108.3 (7–452) in G_NT, respectively. The percentage of patients treated with immunomodulators was 47.6% vs. 47.6% vs. 42.9% in G_control, G_AT and G_TECCU, respectively, and 47.6% vs. 42.9% vs. 47.6% with biologic mono or combo therapy in G_control, G_AT and G_TECCU, respectively. After 24 weeks, the total number of outpatient visits and phone calls was lower in the G_TECCU (72 visits, 12 phone calls) compared with G_AT (85 visits, 118 phone calls) and G_control (131 visits, 47 phone calls), which represent a cost of 3205 vs. 5342 vs. 6210 euros in G_TECCU vs. G_AT vs. G_control, respectively. There were not differences among groups in the number of emergency visits, IBD-related surgeries, hospitalisations, use of corticosteroids and medication adverse effects during the study period. TECCU web program is a safe and innovative tool for management of complex IBD patients, which reduce health care costs in terms of outpatient visits and phone calls.