Telephone Consultation as a Substitute for Routine Out-patient Face-to-face Consultation for Children With Inflammatory Bowel Disease: Randomised Controlled Trial and Economic Evaluation

Anthony K Akobeng, Neil O'Leary, Andy Vail, Nailah Brown, Dono Widiatmoko, Andrew Fagbemi, Adrian G Thomas, Anthony K Akobeng, Neil O'Leary, Andy Vail, Nailah Brown, Dono Widiatmoko, Andrew Fagbemi, Adrian G Thomas

Abstract

Background: Evidence for the use of telephone consultation in childhood inflammatory bowel disease (IBD) is lacking. We aimed to assess the effectiveness and cost consequences of telephone consultation compared with the usual out-patient face-to-face consultation for young people with IBD.

Methods: We conducted a randomised-controlled trial in Manchester, UK, between July 12, 2010 and June 30, 2013. Young people (aged 8-16 years) with IBD were randomized to receive telephone consultation or face-to-face consultation for 24 months. The primary outcome measure was the paediatric IBD-specific IMPACT quality of life (QOL) score at 12 months. Secondary outcome measures included patient satisfaction with consultations, disease course, anthropometric measures, proportion of consultations attended, duration of consultations, and costs to the UK National Health Service (NHS). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02319798.

Findings: Eighty six patients were randomised to receive either telephone consultation (n = 44) or face-to-face consultation (n = 42). Baseline characteristics of the two groups were well balanced. At 12 months, there was no evidence of difference in QOL scores (estimated treatment effect in favour of the telephone consultation group was 5.7 points, 95% CI - 2.9 to 14.3; p = 0.19). Mean consultation times were 9.8 min (IQR 8 to 12.3) for telephone consultation, and 14.3 min (11.6 to 17.0) for face-to-face consultation with an estimated reduction (95% CI) of 4.3 (2.8 to 5.7) min in consultation times (p < 0.001). Telephone consultation had a mean cost of UK£35.41 per patient consultation compared with £51.12 for face-face consultation, difference £15.71 (95% CI 11.8-19.6; P < 0.001).

Interpretation: We found no suggestion of inferiority of telephone consultation compared with face-to-face consultation with regard to improvements in QOL scores, and telephone consultation reduced consultation time and NHS costs. Telephone consultation is a cost-effective alternative to face-to-face consultation for the routine outpatient follow-up of children and adolescents with IBD.

Funding: Research for Patient Benefit Programme, UK National Institute for Health Research.

Keywords: Crohn's disease; Inflammatory bowel disease; Telemedicine; Telephone consultation; Ulcerative colitis.

Figures

Fig. 1
Fig. 1
Trial profile. IMPACT = Paediatric IBD quality of life questionnaire.
Fig. 2
Fig. 2
Dot-plot of all observed IMPACT QOL scores at baseline and 12 month follow-up with medians in each group at each time-point.

References

    1. Afzal N.A., Van Der Zaag-Loonen H.J., Arnaud-Battandier F., Davies S., Murch S., Derkx B., Heuschkel R., Fell J.M. Improvement in quality of life of children with acute Crohn's disease does not parallel mucosal healing after treatment with exclusive enteral nutrition. Aliment. Pharmacol. Ther. 2004;20:167–172.
    1. Aguas Peris M., Del Hoyo J., Bebia P., Faubel R., Barrios A., Bastida G. Telemedicine in inflammatory bowel disease: opportunities and approaches. Inflamm. Bowel Dis. 2015;21:392–399.
    1. Baker R. Development of a questionnaire to assess patient's satisfaction with consultations in general practice. Br. J. Gen. Pract. 1990;40:487–490.
    1. Car J., Sheikh A. Telephone consultations. BMJ. 2003;326:966–969.
    1. Cosgrove M., Al-Atia R.F., Jenkins H.R. The epidemiology of paediatric inflammatory bowel disease. Arch. Dis. Child. 1996;74:460–461.
    1. Curtis L. University of Kent at Canterbury: Personal Social Services Research Unit. 2010. Unit costs of health and social care 2010.
    1. Dunn G., Bentall R. Modelling treatment-effect heterogeneity in randomised controlled trials of complex interventions (psychological treatments) Stat. Med. 2007;26:4719–4745.
    1. Gethins S., Robinson R., de Caestecker J., Stewart J. Impact of a nurse-led telephone clinic on quality of IBD care. Gastrointest. Nurs. 2007;1:34–39.
    1. Gunesh S., Thomas G.A., Williams G.T., Roberts A., Hawthorne A.B. The incidence of Crohn's disease in Cardiff over the last 75 years: an update for 1996–2005. Aliment. Pharmacol. Ther. 2008;27:211–219.
    1. Little R.J.A. Pattern-mixture models for multivariate incomplete data. J. Am. Stat. Assoc. 1993;88:125–134.
    1. Loonen H.J., Grootenhuis M.A., Last B.F., de Haan R.J., Bouquet J., Derkx B.H. Measuring quality of life in children with inflammatory bowel disease: the impact-II (NL) Qual. Life Res. 2002;1:47–56.
    1. Miller L., Caton S., Lynch D. Telephone clinic improved quality of follow-up care for chronic bowel disease. Nurs. Times. 2002;98:36–38.
    1. Nagelkerke N., Fidler V., Bernsen R., Borgdorff M. Estimating treatment effects in randomised clinical trials in the presence of noncompliance. Stat. Med. 2000;19:1849–1864.
    1. Ogden C.A., Akobeng A.K., Abbott J., Aggett P., Sood M.R., Thomas A.G. Validation of an instrument to measure quality of life in British children with inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr. 2011;53:280–286.
    1. Otley A., Smith C., Nicholas D., Munk M., Avolio J., Sherman P.M., Griffiths A.M. The IMPACT questionnaire: a valid measure of health-related quality of life in pediatric inflammatory bowel disease. J. Pediatr. Gastroenterol. Nutr. 2002;35:557–563.
    1. Pinnock H., Adlem L., Gaskin S., Harris J., Snellgrove C., Sheikh A. Accessibility, clinical effectiveness, and practice costs of providing a telephone option for routine asthma reviews: phase IV controlled implementation study. Br. J. Gen. Pract. 2007;57:714–722.
    1. Sawczenko A., Sandhu B.K., Logan R.F., Jenkins H., Taylor C.J., Mian S., Lynn R. Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet. 2001;357:1093–1094.
    1. Shepanski M.A., Markowitz J.E., Mamula P., Hurd L.B., Baldassano R.N. Is an abbreviated Pediatric Crohn's Disease Activity Index better than the original? J. Pediatr. Gastroenterol. Nutr. 2004;39:68–72.
    1. Shepanski M.A., Hurd L.B., Culton K., Markowitz J.E., Mamula P., Baldassano R.N. Health-related quality of life improves in children and adolescents with inflammatory bowel disease after attending a camp sponsored by the Crohn's and Colitis Foundation of America. Inflamm. Bowel Dis. 2005;11:164–170.
    1. Turner D., Otley A.R., Mack D., Hyams J., de Bruijne J., Uusoue K. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007;133:423–432.
    1. Wasson J., Gaudette C., Whaley F., Sauvigne A., Baribeau P., Welch H.G. Telephone care as a substitute for routine clinic follow-up. JAMA. 1992;267:1788–1793.
    1. White I.R., Thompson S.G. Adjusting for partially missing baseline measurements in randomized trials. Stat. Med. 2005;24:993–1007.
    1. White I.R., Royston P., Wood A.M. Multiple imputation using chained equations: issues and guidance for practice. Stat. Med. 2011;30:377–399.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe