How Telemedicine Can Be Effective If You Have IBD

Seeing a practitioner via video call can helpful for people with IBD

Nurse writing in clipboard while using phone for video conference at clinic.

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Telehealth appointments are an increasingly popular way to interact with medical specialists, including those that treat chronic illnesses such as inflammatory bowel disease (IBD), Crohn’s disease, or ulcerative colitis. While the telephone has been used to as a way for doctors and patients to communicate, there are now video conferencing options that allow a healthcare provider to assess your symptoms or provide ongoing management of your condition. Texting and messaging can help solve problems quickly or convey critical information in a time-sensitive situation.

How to Make the Most of Telehealth IBD Appointments
Verywell / Julie Bang

What Is Telemedicine?

Telemedicine is a broad term that encompasses the use of of various forms of telecommunication—including telephone, video calls, texts, email, patient portals, and social media—to provide health care. Now there are a variety of tools available where you and your provider can see and hear each other over video or send real-time messages back and forth.

Physicians may use a telehealth appointment to follow up after an in-person office visit, for example, which helps you avoid travel time or needing to take time off from work. In fact, some healthcare professionals operate solely online or through phone or text. Other practitioners may decide to use telehealth only in certain circumstances or may require a certain ratio of in-person to online visits.

Telehealth may also be more cost-effective for people who have specific medical needs. Healthcare systems may find that more frequent check-ins with people who live with chronic illness, such as IBD, could prevent the need for more extensive treatments. The higher the level of care, the more the costs of certain conditions, like IBD, might be lowered. In other words, an investment in telehealth options might prevent hospitalizations or more intensive treatments, including surgery to treat IBD.

If you require bloodwork or a stool or urine sample, you will still be required to go to your doctor's office or a testing facility.

How Telemedicine Can Help People With IBD

IBD can be challenging to treat, and people with the condition usually see their healthcare providers often when coping with a flare-up. Care for those with Crohn’s disease and ulcerative colitis also tend to expensive and time-consuming.

Telemedicine may be especially useful for those who live in rural areas. In some regions, not only are there no local IBD specialists or centers, but it may require a long drive just to see a gastroenterologist. In this situation, bringing an IBD specialist into the team via telemedicine can offer some much-needed expertise.

Tips to Make the Most of Telehealth Appointments

Unfortunately, a telehealth visit is not as simple as jumping on a video call. There are, however, some ways to ensure that the process goes more smoothly for everyone.

  • Fill out all the necessary paperwork. Just as there is paperwork to be completed at every in-person visit, paperwork must be completed before a telehealth visit. If all the necessary forms aren’t completed before the visit, there’s a risk of not being able to have the appointment or having difficulties with insurance coverage.
  • Contact the insurance company. Before a telehealth appointment, especially if it is with a new practitioner, call your insurance company to find out if there are any costs for which you are responsible. Copay, coinsurance, and deductible structures may be different for telehealth visits.
  • Practice with the telehealth tool prior to the appointment. It may be necessary to download some software or a plug-in. Doing this before the visit will allow any technical problems to be solved beforehand. Call the doctor’s office if you have any questions or concerns about how to use the technology.
  • Create the right space for the visit. A quiet room that offers privacy and minimal distractions is ideal for ensuring that a telehealth visit goes well.
  • Prepare as if it is an in-person visit. Have notes and questions on hand, as well as any medications to ensure that refills are processed in a timely way. The only thing that should be different about the visit is that a physician can’t conduct a hands-on physical exam. 

The Evidence Supporting Telemedicine in IBD

One of the first studies done on telemedicine in IBD was a year-long pilot trial on people with ulcerative colitis. While some patients did find telemedicine helpful and reported an improvement in their quality of life improved, the system was difficult to manage for other patients. Still, the researchers concluded that there was potential for telehealth to be used in the treatment of IBD.

Another trial done in Spain investigated a specialized web-based system called Telemonitoring of Crohn’s Disease and Ulcerative Colitis [TECCU]. Sixty-three patients were recruited and randomized to either using TECCU, receiving nursing care over the phone, or going about their usual care protocol in a clinic. What researchers found was that the use of TECCU offered both improved care and cost reduction. They stress, however, that a larger study is needed before the methods can be deployed on a wider scale.

Another advantage of telemedicine is the ability to help educate patients about their disease. IBD is complex and many patients face a steep learning curve at diagnosis. One small study of 21 patients diagnosed with ulcerative colitis measured how well patients fared through the use of a web-based treatment program as compared to a patient education center over the course of six months. The results showed that knowledge of IBD was “significantly" increased with the use of the web-based program.

A larger trial of web-based learning included 95 patients with mild to moderate ulcerative colitis. Patients were receiving mesalazine to treat ulcerative colitis and were monitored for fecal calprotectin (a marker of inflammation) once a week. An online survey, called the simple clinical colitis activity index (SCCAI), measured the severity of disease by asking patients five questions about their ulcerative colitis symptoms. The higher the score, the more disease activity. Eighty-six percent of the patients completed the program for three months. Researchers noted that there were lower SCCAI scores and fecal calprotectin in patients over the span of the study.

Barriers to Telemedicine

Even though telemedicine is shown to be effective for certain scenarios, there are several barriers to its use.

Logistics

In-person appointments for even routine reasons are how most medical practices work. Setting up a way to work with patients remotely requires time, energy, money, and a desire to make the practice work. Some of these barriers have been overcome out of necessity in the era of the novel coronavirus (SARS-CoV-2) and physical distancing.

Billing

Another common barrier is in billing. Billing for medical care via telehealth was not set up for many institutions, which hindered its use. Now, both Medicare and Medicaid can be billed for telehealth services. Some institutions or practices may work with insurance to reimburse them for telehealth visits (many of the large payers now will pay for telehealth) or they may offer it on a cash basis. This is an area that’s going to be variable between practices and patients and providers will need to work together to come to a solution for payment. Patients should check with their providers and their insurance company.

Privacy

A major hurdle for telehealth regards compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). During a national public health emergency, the Office for Civil Rights at the Department of Health and Human Services, which is responsible for overseeing HIPAA compliance, does not enforce penalties for noncompliance. In other words, when providers are, in good faith, using their best judgment and discretion to care for patients via telehealth, some flexibility is granted. Going forward, it remains to be seen how HIPAA will be viewed, enforced, or even amended to accommodate the sudden expansion of telehealth services. 

IBD and Patient Adherence

One area where telehealth may help people with IBD manage their condition is in medication adherence (sometimes referred to as compliance by healthcare professionals). People who live with IBD sometimes take several medications; taking them all on time and as directed may be a challenge for many different reasons. Having frequent check-ins with a healthcare provider about medications and issues such as side effects can keep you on track.

A World From Verywell

Telehealth can’t replace all appointments, as IBD also requires in-person lab tests. If you have IBD, ask your provider about the availability of telehealth, especially as it relates to specialists and subspecialists. For example, it may be possible to bring in a consult from a specialist on the other side of the country without anyone having to travel. Again, be sure to contact your insurance company about their policies regarding telemedicine coverage before your appointment.

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Article Sources
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  3. Elkjaer M, Burisch J, Avnstrøm S, Lynge E, Munkholm P. Development of a Web-based concept for patients with ulcerative colitis and 5-aminosalicylic acid treatment. Eur J Gastroenterol Hepatol. 2010;22:695-704. doi:10.1097/MEG.0b013e32832e0a18

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