web-guided ' Constant-care ' approach colitis : a randomised controlled trial of the E-health empowers patients with ulcerative

Background The natural history of ulcerative colitis requires continuous monitoring of medical treatment via frequent outpatient visits. The European health authorities’ focus on e-health is increasing. Lack of easy access to inflammatory bowel disease (IBD) clinics, patients’ education and understanding of the importance of early treatment at relapse is leading to poor compliance. To overcome these limitations a randomised control trial ‘Constant-care’ was undertaken in Denmark and Ireland. Methods 333 patients with mild/moderate ulcerative colitis and 5-aminosalicylate acid treatment were randomised to either a web-group receiving disease specific education and self-treatment via http://www. constant-care.dk or a control group continuing the usual care for 12 months. A historical control group was included to test the comparability with the control group. We investigated: feasibility of the approach, its influence on patients’ compliance, knowledge, quality of life (QoL), disease outcomes, safety and health care costs. Results 88% of the web patients preferred using the new approach. Adherence to 4 weeks of acute treatment was increased by 31% in Denmark and 44% in Ireland compared to the control groups. In Denmark IBD knowledge and QoL were significantly improved in web patients. Median relapse duration was 18 days (95% CI 10 to 21) in the web versus 77 days (95% CI 46 to 108) in the control group. The number of acute and routine visits to the outpatient clinic was lower in the web than in the control group, resulting in a saving of 189 euro/ patient/year. No difference in the relapse frequency, hospitalisation, surgery or adverse events was observed. The historical control group was comparable with the control group. Conclusion The new web-guided approach on http://www.constant-care.dk is feasible, safe and cost effective. It empowers patients with ulcerative colitis without increasing their morbidity and depression. It has yet to be shown whether this strategy can change the natural disease course of ulcerative colitis in the long term. BACKGROUND The natural history of ulcerative colitis is characterised by relapses and remissions. The majority of patients with ulcerative colitis (91%) have a mildto-moderate disease course eligible for 5-aminosalicylate acid (5-ASA) treatment. To prevent relapses, colectomy and colonic cancer there is Significance of this study What is already known about this subject? < Poor compliance with 5-aminosalicylic acid (5ASA) treatment in ulcerative colitis due to lack of easy access to specialised inflammatory bowel disease (IBD) clinics, lack of patient education and understanding of the importance of early treatment at relapse. < Web-based concept in therapy of other chronic diseases improves the disease course, optimise patients‘ self-adherence, compliance, QoL and generates economic benefits for the healthcare system. < The European Council and National Health Insurance in North America have focused on empowering patients and minimising healthcare costs using new technology. What are the new findings? < The new web-guided approach on http://www. constant-care.dk is feasible, safe and costeffective for patients with ulcerative colitis. < The concept increases patients‘ compliance, quality of life (QoL), and empowerment to selfinitiated treatment, and it reduces healthcare costs. < The web-based treatment strategy significantly decreased the duration of relapse. How might it impact on clinical practice in the foreseeable future? < The new web-guided approach ‘Constant-care’ is in accordance with an action plan for a European e-Health Area, which gives patients important opportunities for improved access to better and more efficient healthcare. < Widespread implementation of the ‘Constantcare’ approach may reshape the current healthcare. < It empowers patients with ulcerative colitis in disease self-management, reduces dependency on doctors and it might possibly change the natural disease course in the long term. < The ‘Constant-care’ approach can be accommodated and used in more severe IBD patients, in some patients after surgery (pouch) and also in patients with other chronic conditions. < Additional data are published online only. To view these files please visit the journal online (http://gut.bmj.com). Digestive Disease Center Herlev Hospital, Medical Section, University of Copenhagen, Denmark Department of Gastroenterology, Adelaide and Meath Hospital incorporating the National Children Hospital/Trinity College Dublin, Dublin, Ireland Department of Medical Gastroenterology, Amager Hospital, Copenhagen, Denmark Department of Medical Gastroenterology, Gentofte Hospital, Copenhagen, Denmark Institute of Public Health, Copenhagen, Denmark Correspondence to Dr Pia Munkholm, Digestive Disease Center, Medical Section, Herlev University Hospital Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark; piamun01@heh.regionh. dk Revised 27 August 2010 Accepted 9 September 201