TELEHEALTH ENHANCES RETENTION OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE WITHIN A TERTIARY CARE INFLAMMATORY BOWEL DISEASE CENTER
Authors: Olson Jeffrey , Beaulieu Dawn , Bennett Audrey , Dalal Robin , Pabla Baldeep , Scoville Elizabeth , McCoy Allison , Horst Sara 
Published: January 2024

Abstract

INTRODUCTION
Telehealth care in the ambulatory setting has dramatically increased in the COVID and post-COVID period in medicine. Understanding how this may impact the care of patients (pts) with inflammatory bowel disease (IBD) is important. This study aims to evaluate the pattern of use of telehealth care in a tertiary care IBD center.

METHODS
Pts seen at a tertiary care IBD center from January 2018 to March 2020 and August 2020 to January 2023 were included. Pts seen between March 2020 and July 2020 were excluded as the institution had mandatory telehealth visits during this period. Data was obtained from the Electronic Medical Record after IRB approval. Office visit types were based on billing codes, and office visits were only included in the analysis if seen by an MD or Advanced practice provider (APP). Drive time in minutes (min) was established from pt addresses using Esri geographic information systems (GIS) data, services and software. All new pts seen in the IBD Center are required to be seen in-clinic. After August 2020, pts seen in follow up can be seen at an in-clinic visit or via telehealth at the patient’s preference. Statistical analysis included Pearson Chi Square analysis for categorical variables and z-tests for means comparisons for continuous variables.

RESULTS
A total of 7,040 pts included. 56% were female. 89% were white, 7% Black or African American, and 76% had commercial health insurance, 17% had Medicare, 4% Medicaid, and 3% had no health insurance. New pts seen in the post-Covid period had shorter drive times than those seen in the pre-Covid period. (Table 1) Pts who had at least one year of follow up were more likely to be seen as a return visit in the post-Covid period vs the pre-Covid period (84% vs 76%, p&lt;0.05). In the post-Covid period, 62% (3,575/5,750) pts had return IBD care by their MD or APP team delivered via telehealth. Pts seen in telehealth had significantly longer drive times than in-clinic-only pts (median 56.3 min [IQR 93.3] vs median 47.9 min [IQR 89.7]), p&lt;0.001. (Table 2) This was significant for both the telehealth pts who had been seen in-clinic in the pre-Covid period as well as pts who were seen only in the post-Covid period. Pts who continued care only with in-clinic visits in the post-Covid period had significantly shorter drive times than pts who were seen in-clinic pre-Covid (38.8 min [IQR 60] vs 54.2 min [IQR 89.9]), p&lt;0.001.

CONCLUSION
Telehealth is an effective strategy for continued multidisciplinary care at a tertiary care IBD center. More than half of patients continuing to participate in telehealth for follow up care, and patients were more likely to follow up in the post-Covid period. Patients who live farther away are more likely to continue IBD care via telehealth.

Table 1 Overall Drive Time for New patients in the Pre- and Post-COVID periods

Table 2 Drive Times for Return patients in the Pre-Covid and Post-Covid periods