番茄社区

LAS VEGAS -- A tertiary care inflammatory bowel disease (IBD) clinic had greater retention of patients when telehealth became an option for return visits during the COVID-19 pandemic, according to a retrospective analysis.

Patients with at least 1 year of follow-up were more likely to have a return visit from August 2020 to January 2023, when telehealth was an option, compared with the pre-COVID period when only in-person visits were possible for return care (84% vs 76%, P<0.05), reported Sarah Horst, MD, MPH, of Vanderbilt University Medical Center in Nashville, Tennessee, at the Crohn's & Colitis Congress.

In the post-COVID period, 62% of patients had return IBD care by their physician or advanced practice provider delivered via telehealth.

Horst and colleagues also compared the median drive times for pre-COVID return patients to the median drive times for post-COVID return patients based on whether they visited the clinic in person or used telehealth. Before COVID, return patients had a median drive time of 54.2 minutes. After telehealth became available post-COVID, however, the median drive time for return patients visiting only in-person fell to a median 38.8 minutes (P<0.001), while the median drive time for telehealth return patients was 56.3 minutes (P<0.001 vs pre-COVID).

"What was happening before is that we would do a one-time consult and then send the patient back to their primary gastroenterologist," Horst said. Though gastroenterologists provide the required care, the IBD specialty clinic has "a multidisciplinary care team with dietitians, social workers, psychologists, specialty pharmacists, [and] nurse navigators," as well as other support staff, she explained.

For the complex IBD patient, the advantages of the specialty clinic include access to that team and to more clinical trials. In the past, patients may not have returned for those advantages if they had to drive hours each way every 6 months, Horst said, but telehealth has enabled the clinic "to keep these patients within our system and be able to continue to give them that high-quality care."

Jeffrey Dueker, MD, MPH, of the University of Pittsburgh, who was not involved in the study, but discussed the findings with Horst at the meeting, said his institution is similarly looking at ways telehealth can expand access to rural patients in Pennsylvania.

"Where you live should not have to dictate your access to high-quality IBD care," Dueker told 番茄社区. "I really think that this model is going to be the future for IBD care going forward. Sustained telehealth is really where things are going."

The clinic saw increases in return patients after COVID regardless of their drive times. The percentage of patients who returned increased from 87% pre-COVID to 90% post-COVID for patients who lived less than 30 minutes from the clinic, from 88% to 92% for patients who lived less than 1 hour from the clinic, and from 89% to 93% for patients who lived less than 2 hours from the clinic.

For patients who lived less than 3 hours from the clinic, 93% returned post-COVID, when telehealth was an option, compared with 83% pre-COVID, when only in-person visits were possible for return patients. Similarly, for patients who had to drive more than 3 hours to reach the clinic, 90% of post-COVID patients returned versus 77% of pre-COVID patients.

For this study, Horst and team analyzed data on patients seen at a tertiary IBD center from January 2018 to March 2020 and from August 2020 to January 2023. They excluded visits between March 2020 and July 2020 since the institution required all visits to be telehealth during that time. New patients' first visit had to be in-person at the IBD center, but they could choose their follow-up appointments to be in-person or via telehealth from August 2020 onward.

The researchers used billing codes to determine if each visit was new or return (any visits after the first one), whether the visit occurred pre-COVID or post-COVID, and whether it occurred in the clinic or via telehealth. They also used Esri geographic information systems and patients' addresses to determine median drive times Monday to Friday between each patient's home and the clinic. They noted that 1.9 million people lived within an hour's drive of the clinic, while 6.9 million people lived between 1 and 3 hours away, and 17.2 million people lived more than 3 hours away.

Among 7,040 patients included in the study, 56% were women, 89% were white, and 7% were Black or African American. Most of the patients (76%) had commercial health insurance, while 17% had Medicare, 4% used Medicaid, and 3% had no health insurance.

Dueker acknowledged that a potential barrier to telehealth's ability to expand access to care relates to the geographic restrictions of physicians' licenses. Specialists at Vanderbilt's IBD clinic participate in the Interstate Medical Licensure Compact, which enables them to also provide care to patients in Kentucky and Alabama.

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