How Telemedicine Can Work for IBD

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

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

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Telehealth appointments are a newer way to interact with medical specialists. The internet has allowed people with inflammatory bowel disease (IBD) to connect and find support on their journey. People living with Crohn’s disease or ulcerative colitis can find other people living with these diseases as well as advocacy groups and health care professionals online in order to share information. The next logical step is to take advantage of the many online tools we have to see doctors for management and treatment.

While the telephone has been used to deliver medical care for decades, there are now video conferencing options that can help a healthcare provider see their patient in order to make a better assessment. Texting and messaging can help solve problems quickly or convey critical information in a time-sensitive situation. What might telehealth appointments look like and would this type of medical care work for you?

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

What Is Telemedicine?

Telemedicine is a broad term that encompasses receiving health services using telecommunication. Telecommunication can include telephone, video calls, texts, email, patient portals, or social media. When you think about it, contacting a doctor or nurse by phone is telemedicine, so it is likely you have already been using it, even without the internet. However, 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.

The idea of using expanded telehealth has become more prevalent in recent years for a few reasons. One is that insurance companies are looking to manage costs, and telehealth may be more cost-effective for people who have specific medical needs.

Another is that healthcare systems may find that more frequent check-ins with people who live with chronic illness, such as IBD, could result in more comprehensive care. The higher the level of care, the more the costs of certain conditions, like IBD, might be lowered through working more closely with healthcare providers. In other words, an investment in telehealth options might save the costs of, for instance, hospitalizations or more intensive treatments, including surgery to treat IBD.

How Practitioners Use Telehealth

There are several different ways that healthcare providers use telehealth to connect with patients. For instance, physicians may use a telehealth appointment to follow-up after an in-person office visit in order to allow for flexibility. This ensures that patients are still sometimes seen in the office but a telehealth appointment could help in avoiding travel time or taking time off from work to manage their chronic illness. As well, some healthcare professionals operate solely online or through phone or text.

Clinicians may work with insurance companies to set up a payment structure or may accept payment outright from patients (which is sometimes called concierge or retainer medicine).

The guidelines for using these services will be determined by the provider. When texting is an option, there may be guardrails put around how often and when patients can access the service. Practitioners may decide to use telehealth only in certain circumstances or may require a certain ratio of in-person to online visits.

Testing is not an option for telehealth, so any visit that needs bloodwork or a stool or urine sample would still require you to visit a facility to have the sample taken.

How Telemedicine Can Help People With IBD

IBD is difficult to treat and complicated; those with the condition usually see their healthcare providers often when coping with a flare-up. Crohn’s disease and ulcerative colitis also tend to be expensive and time-intensive. Using telemedicine could be helpful when people have long distances to travel to see practitioners or are finding it difficult to work doctor’s appointments into a busy schedule.

Telemedicine could be of special help for those who live in rural areas. In some regions, not only are there no local IBD specialists or centers, but it may be a long drive to see a gastroenterologist at all. In this situation, bringing an IBD specialist into the team via telemedicine could help bring some much-needed expertise.

Tips to Make the Most of Telehealth Appointments

Unfortunately, telehealth 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, it’s the same for telehealth. A physician’s office should be asking for the completion of some paperwork, and if that’s not the case, you should ask what’s needed before the 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 having a telehealth appointment, especially if it is with a new practitioner, call the insurance company to find out if there are any costs for which you are responsible. Copay, coinsurance, and deductible structures may be different when telehealth is used.
  • 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 help make the visit easier because hopefully any technical problems can be solved beforehand. Call the doctor’s office if there are any questions or concerns about the technology being used.
  • Create the right space for the visit. A quiet room without distractions is going to be helpful for ensuring that a telehealth visit goes well. It may be a challenge to create this space but it will help with both privacy concerns and in avoiding a disruption that takes away from the treatment goals of the visit.
  • 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 physical exam in the same way. 

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 indeed, their quality of life improved, the system was difficult to manage and other patients dropped out. The researchers decided that there was potential for telehealth to be used in the treatment of IBD.

Another study looked at 68 papers about mobile health apps and their use in IBD. The researchers expounded on how the management of IBD is evolving and that could affect the utility of telemedicine in treating Crohn’s disease and ulcerative colitis. The guidelines for managing IBD are moving away from treating symptoms (how a person feels) to treating inflammation (the damage done to the body by the disease). People with IBD could feel “well” but still have inflammation in their digestive system. In order to assess inflammation, lab work needs to be done, and that can’t yet be done over the phone, in a text, or via a video call.

Another trial done in Spain investigated a specialized web-based system (called Telemonitoring of Crohn’s Disease and Ulcerative Colitis [TECCU]). There were 63 patients recruited and were randomized to either using TECCU, receiving nursing care over the phone, or going about their usual care protocol in 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 aspect 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 a web-based treatment program (https://ibd.constant-care.com/) or a patient education center for six months. The results showed that knowledge of IBD was “significantly" increased with the use of these programs.

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. The survey used is called the simple clinical colitis activity index (SCCAI) and it measures the severity of disease by asking patients 5 questions about their ulcerative colitis symptoms. The higher the score, the more disease activity that causes symptoms is taking place. 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. This is being unraveled out of necessity and 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 (use the phone number or the web site on the back of the card).

Privacy

A major hurdle for telehealth is being able to be in 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, is not enforcing 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 being 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 aspect where telehealth might be uniquely suited to helping people with IBD manage their condition is in adherence. (Sometimes referred to as compliance by healthcare professionals). People who live with IBD sometimes take several medications; taking them all on time may be a challenge for many different reasons. The studies that show that telehealth may help with the management of IBD show that one area of benefit is in taking medications on time, and/or changing the medication schedule when symptoms crop up. Having frequent touchpoints with a healthcare provider about medications and issues such as side effects or insurance coverage may be helpful in taking medications as needed.

A World From Verywell

IBD is complicated. It requires management from an experienced team of providers and, in many cases, frequent appointments to ensure that all needs are being met. For some patients, the burden of attending in-person appointments can be overwhelming, especially for those who live in areas where there are no IBD specialists available. Telehealth can open up access to specialists in a way that doesn’t involve travel and time off from work, which are major barriers to receiving better care.

Telehealth can’t replace all appointments: IBD is also managed with the use of many tests, for which patients would still need to be seen in-person. However, there are many scenarios in the day-to-day management of IBD when a telehealth appointment with a provider could be helpful. People with IBD should ask their providers 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. Patients should also check with their insurance company about the availability of telehealth, as some payers may already have structures set in place to provide this type of care. 

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Article Sources
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