N001 Telephone vs clinic follow-up in the management of patients with inflammatory bowel disease: a nurse practitioner-led study
U. Chauhan*1, D. Armstrong2, S.L. Halder2, J. K. Marshall2, F. Tse2, M. I. Pinto Sanchez2, Y. Farbod2, J. Popov2, S. Kaasalainen3, P. Moayyedi2
1McMaster University Medical Centre, Digestive Disease, Hamilton, Canada, 2McMaster University, Department of Gastroenterology, Hamilton, Canada, 3McMaster University, School Of Nursing, Hamilton, Canada
Management of inflammatory bowel disease (IBD) requires frequent contact with health care providers, but clinic visits impose an economic burden and can cause psychosocial distress. This study examines the effectiveness of telephone contact versus a clinic appointment amongst patients followed for IBD.
This is a mixed method study design. Consecutive IBD patients were randomly assigned to either clinic follow-up visit (CFV) by an IBD nurse practitioner or telephone follow-up visit (TFV) with an IBD nurse practitioner 3 months after their current appointment. Standardised questionnaires, including demographics, IBD phenotype, disease activity, medication, quality of life, resource utilisation, anxiety, and depression were completed at baseline and 6 months visits using an on-line survey. Patient satisfaction and preference were evaluated in focus group sessions.
Sixty patients were recruited from the outpatient clinic at McMaster Medical Centre. There were no differences in the basic demographic between both groups (Table 1). The average parking and travel costs for patients randomised to CFV were CAN $25.83, and their average loss of income was CAN $17.00. The median duration of health care contact was longer in the CFV group (52 minutes [IQR 38–81] vs 17 minutes [IQR 15.0–21.2]; p = <0.01), with wait time was longer in CFV (median 31.6 minutes [IQR 8–56] vs 0 minutes p < 0.01). Rates of interim health care contact did not differ between the 2 arms. No significant change in health-related quality of life (Short Inflammatory Bowel Disease Questionnaire) or satisfaction (Patient Satisfaction Questionnaire) from baseline to 6-month follow-up was observed. There was also no significant change in C-reactive protein (CRP), Harvey–Bradshaw Index (Crohn’s disease) or Partial Mayo Score (ulcerative colitis). At 6 months, subjects in the TFV arm had lower median total HADS score (8 vs 12, p = 0.045) and lower median HADS depression score (p = 0.046). A common theme mentioned by TFV subjects in focus groups was their satisfaction with time and money saved via telephone communication. Depending on their circumstances, the patients preferred telephone visits when in remission and clinic visits during relapse of their disease.
Our feasibility study has shown that telephone visit is cost saving and preferred by patients with IBD. This mode of follow-up care was also associated with better anxiety and depression scores. Further research is needed to explore how TFV can best be integrated in patient management algorithms.