An integrated eHealth strategy to optimise outpatient disease and psychological management in inflammatory bowel disease

Abstract

The increasing incidence of inflammatory bowel disease (IBD) over the past decade has resulted in increased health care resource utilisation and longer specialist outpatient waiting lists. IBD is associated with an increased prevalence of psychological morbidity and adversely affects quality of life, societal interaction and functioning. Electronic-health or ‘eHealth’ technologies incorporating self-management strategies to manage patients remotely such as telemedicine, web-based interventions, and smart-phone applications may offer a solution to streamline outpatient management, by detecting earlier changes in patient well-being (disease activity, medication status and psychological health) and providing greater access to personalised care in real-time. However, whether eHealth technologies offer any significant benefit over traditional outpatient based IBD care remains to be proven.

This thesis encompasses a framework and the design of a decision support tool which aims to improve the outpatient management of IBD patients by proving that eHealth monitoring of patients with mild-to-moderate ulcerative colitis, stratified for disease activity and psychological distress and treated according to a fixed regime of eHealth directed self-management, is an effective model of care compared with IBD clinic-led outpatient management.

A colloquium was initially held to obtain key stakeholders’ perspectives on the role of an eHealth tool to facilitate decision support for IBD. Retrospective studies were then undertaken to establish the extent to which gastroenterologists adhere to evidence based international guidelines in clinical practice. A cost analysis study was conducted to describe the current cost of care and to compare the costs associated with treating active disease compared to disease in remission. A cross-sectional study was then undertaken to establish the relationship between patient-reported outcomes and disease activity. Patient perspectives regarding the potential value of an eHealth intervention for outpatient IBD management were then explored. Finally, clinical algorithms were developed for disease activity, psychological wellbeing and preventive care and incorporated into a decision support tool which was assessed for feasibility, usability and acceptability compared to standard IBD care. In summary, this is the first prospective study to demonstrate that an eHealth tool to facilitate decision support significantly improves the delivery of quality care and promotes shared decision-making in patients with mild-to-moderate ulcerative colitis.