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P433. Is e-Health, web-based monitoring and treatment, useful for children and adolescents with inflammatory bowel disease? - a paediatric clinical trial

K. Carlsen1,2, C. Jakobsen1, L.F. Hansen1, A. Paerregaard1, V. Wewer1, P. Munkholm2, 1Copenhagen University Hospital, Department of Paediatrics, Hvidovre, Denmark, 2Copenhagen University Hospital, Department of Gastroenterology, Herlev, Denmark

Background

e-Health, web-based monitoring, decrease time from relapse to remission and improve adherence and Quality of Life (QoL) in adult patients with Inflammatory Bowel Disease (IBD) [1,2]. Adherence to medicine in young patients with IBD is low [3]. It is our hypothesis that e-Health can optimize adherence and empower young patients (10–17 years) by integrating themselves in their own disease course.

Methods

The adult e-Health web-program Constant Care (ConstantMED©) is used as a basis to design the web program for young patients. In www.young.constant-care.com paediatric IBD scores (PUCAI and abbPCDAI), medication, need for corticosteroids, QoL (IMPACT III questionnaire), adherence (Medication Adherence Report Scale and Visual Analog Scale), days of absence from school, need for contact to the hospital, surgery and hospitalizations are measured. Two studies are designed to evaluate the value of the web-program: study A, patients treated with self-administrated medicine and study B, patients treated with Infliximab.

The patients enter their symptoms in the web-program and submit a stool sample for fecal calprotectin (FC) analysis at regular intervals. Disease burden is estimated using a combination of FC levels and PUCAI/abbPCDAI. The results are shown to the patient into a traffic light curve - red colour indicating severe disease activity, yellow colour light to moderate activity and green colour inactive disease. Depending on the colour different advises are given to the patient. The medical doctor monitors the patients by web-rounds weekly.

Results

www.young.constant-care.com is now constructed and available to the young patients. A total of 121 patients aged 10–17 years old have been invited to participate in the projects (83 in project A, 38 in project B). After a 2.5 months of inclusion 53 patients are included, 34 in study A and 19 in study B. 3 patients have been excluded. 42% (51/121) patients were not interested in participating giving following reasons: (1) too time consuming (n = 6); (2) no wish to be reminded of the disease (n = 5); (3) problems with submitting fecal samples (n = 2); (4) other reasons (n = 15); (5) no response to approach (n = 23). Ratio of number entries in the web-program per expected entries is 0.89 (40/45). Ratio of submitted fecal test per expected is 0.85 (23/27).

Conclusion

www.young.constant-care.com is established and ready to use. The rate of entries and submitted stool samples indicate that patients in the age group 10–17 years can and are interested in the use of the e-Health system and that regular fecal sampling for monitoring disease activity is possible in this age group.

1. Elkjaer M Gut 2010.

2. Pedersen N APT 2012.

3. LeLeiko N IBD 2012.