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P432 MyChart application in addressing Inflammatory Bowel Disease patients’ concerns and impact on service utilisation

P Raman, K.(1);Agorogianni, A.(1);Hadjinicolaou, A.(1);Nightingale, A.(1);Mayhew, A.(1);Munro, R.(1);Raine, T.(1);McDermott, E.(1);

(1)Cambridge University Hospitals NHS Foundation Trust, Gastroenterology, Cambridge, United Kingdom

Background

MyChart is a novel electronic portal within the electronic patient record provider EPIC.  IBD patients were asked to complete an electronic questionnaire via MyChart prior to their infliximab infusions. A threshold was set that any patient who recorded a severe disease activity score (Mayo >/3, Harvey-Bradshaw Index (HBI) >/8) or signalled a concern created an automatic message that was routed to our clinical nurse specialists.

Methods

Electronic notes of all IBD patients who received infliximab in the month of September 2020 were reviewed. Demographics, activity status of My Chart, type of concerns raised and outcomes, number of inpatient admissions and outpatient appointments pre- and post- the introduction of the online questionnaire were recorded. Clinical remission was defined as Mayo score of <3 or HBI score of <5. Statistical comparisons were performed in GraphPad Prism software using the exact Fisher’s test and student t-test accordingly. Values were deemed significant if p<0.05.

Results

140 IBD patients on infliximab were identified; 2 were excluded due to incomplete data. The cohort comprised of 77 males (55.8%) with mean age of 27 years (SD of 15.1).110 (78.70%) patients had a diagnosis of Crohn’s disease whereas 24 (17.0%) had ulcerative colitis and 4 (2.8%) unspecified type IBD. 104 (75.1%) patients were active on MyChart and 83 (58.9% of total; n=138) completed the infliximab questionnaire. 

Significantly fewer of the patients active on MyChart required scheduled outpatient reviews when compared to those that were inactive (59.6% vs 94.1%; p=0.0001; Table 1). There were no significant differences in terms of demographics, IBD type or clinical remission between the two groups.

Strikingly, patients who did not fill in the questionnaire were significantly more likely to have scheduled outpatient review in comparison to those that filled it (83.6% vs 67.4%; p=0.047) despite a higher proportion of the first being in clinical remission at baseline (86.6% vs 67.4%; p=0.047). 

Furthermore, we evaluated the impact of introducing the online questionnaire by looking at the outpatient reviews and inpatient admissions before and after patients filled it in. The group was significantly less likely to require outpatient reviews (67.5% vs 87.3%; p=0.0061) or inpatient admissions (6.0% vs 17.5%; p=0.03) following introduction of the online questionnaire (Figure 1).




Conclusion

Overall, patients active on MyChart seemed to be significantly less likely to require outpatient review. This impact seemed particularly evident after filling in an online questionnaire which effectively addressed patient concerns and prevented unwarranted outpatient reviews and inpatient admissions. 

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