Disparity in Crohn’s disease activity between home and clinics is associated with unscheduled hospital visits due to disease flares
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Background/Aims: E-health technologies have been implemented for the management of Crohn’s disease (CD). We aimed to identify differences between patient activities at home and at routine clinic visits using a web-based self-reporting CD symptom diary (CDSD) and to determine the impact of this disparity on clinical outcomes. Methods: Patients with CD from three tertiary hospitals were invited to assess their symptoms at least once a week using CDSD. We identified patients who showed disparities in disease activity (high activity at home but normal at the next hospital visit) and evaluated clinical outcomes of these patients such as unscheduled visits due to flares using Kaplan-Meier analyses. Results: One hundred and forty-three patients recorded their symptoms weekly for at least 3 consecutive months and were included. Forty-eight patients (33.6%) showed disparate disease activities between at home and at the next outpatient clinic visit. The cumulative risk of unscheduled visits was significantly higher in this disparity group than in the concordant group (p = 0.001). Disparity in activity (p = 0.003), and anti-tumor necrosis factor use (p = 0.002) were independent risk factors of unscheduled visits due to disease flares. Conclusions: Disparity in disease activity is considerable in CD patients and is related to the risk of unscheduled hospital visit.
Abstract
Background/Aims: E-health technologies have been implemented for the management of Crohn’s disease (CD). We aimed to identify differences between patient activities at home and at routine clinic visits using a web-based self-reporting CD symptom diary (CDSD) and to determine the impact of this disparity on clinical outcomes. Methods: Patients with CD from three tertiary hospitals were invited to assess their symptoms at least once a week using CDSD. We identified patients who showed disparities in disease activity (high activity at home but normal at the next hospital visit) and evaluated clinical outcomes of these patients such as unscheduled visits due to flares using Kaplan-Meier analyses. Results: One hundred and forty-three patients recorded their symptoms weekly for at least 3 consecutive months and were included. Forty-eight patients (33.6%) showed disparate disease activities between at home and at the next outpatient clinic visit. The cumulative risk of unscheduled visits was significantly higher in this disparity group than in the concordant group (p = 0.001). Disparity in activity (p = 0.003), and anti-tumor necrosis factor use (p = 0.002) were independent risk factors of unscheduled visits due to disease flares. Conclusions: Disparity in disease activity is considerable in CD patients and is related to the risk of unscheduled hospital visit.
참고문헌 (19)
- Vermeire S, "Review article: altering the natural history of Crohn's disease: evidence for and against current therapies", Aliment Pharmacol Ther, 25, pp.3~12 (2007)[DOI]
- Veloso FT, "Clinical outcome of Crohn's disease: analysis according to the Vienna classification and clinical activity", Inflamm Bowel Dis, 7, pp.306~313 (2001)[DOI]
- Sands BE, "A survey of methodological variation in the Crohn's disease activity index", Inflamm Bowel Dis, 11, pp.133~138 (2005)[DOI]
- Haas L, "National standards for diabetes self-management education and support", Diabetes Care, 36(Suppl 1), pp.S100~S108 (2013)[DOI]
- Heneghan C, "Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data", Lancet, 379, pp.322~334 (2012)[DOI]
- Elkjaer M, "E-health empowers patients with ulcerative colitis: a randomised controlled trial of the web-guided 'Constant-care' approach", Gut, 59, pp.1652~1661 (2010)[DOI]
- Van Deen WK, "Development and validation of an inflammatory bowel diseases monitoring index for use with mobile health technologies", Clin Gastroenterol Hepatol, 14, pp.1742~1750 (2016)[DOI]
- Kim ES, "Development of a webbased, self-reporting symptom diary for Crohn's disease, and its correlation with the Crohn's Disease Activity Index: web-based, self-reporting symptom diary for Crohn's Disease", J Crohns Colitis, 11, pp.1449~1455 (2017)
- Jensen RE, "The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care", Med Care, 53, pp.153~159 (2015)[DOI]
- Williet N, "Patient-reported outcomes as primary end points in clinical trials of inflammatory bowel disease", Clin Gastroenterol Hepatol, 12, pp.1246~1256 (2014)[DOI]
- Ramos-Rivers C, "Association between telephone activity and features of patients with inflammatory bowel disease", Clin Gastroenterol Hepatol, 12, pp.986~994 (2014)[DOI]
- Sulz MC, "Predictors for hospitalization and outpatient visits in patients with inflammatory bowel disease: results from the Swiss Inflammatory Bowel Disease Cohort Study", Eur J Gastroenterol Hepatol, 25, pp.790~797 (2013)[DOI]
- Nguyen GC, "Health care utilization in elderly onset inflammatory bowel disease: a population-based study", Inflamm Bowel Dis, 21, pp.777~782 (2015)[DOI]
- Gajendran M, "Analysis of hospital-based emergency department visits for inflammatory bowel disease in the USA", Dig Dis Sci, 61, pp.389~399 (2016)[DOI]
- Aguas Peris M, "Telemedicine in inflammatory bowel disease: opportunities and approaches", Inflamm Bowel Dis, 21, pp.392~399 (2015)[DOI]
- Cross RK, "Randomized, controlled trial of home telemanagement in patients with ulcerative colitis (UC HAT)", Inflamm Bowel Dis, 18, pp.1018~1025 (2012)[DOI]
- Cross RK, "Telemedicine for patients with inflammatory bowel disease (TELEIBD): design and implementation of randomized clinical trial", Contemp Clin Trials, 42, pp.132~144 (2015)[DOI]
- Lazarev M, "Relationship between proximal Crohn's disease location and disease behavior and surgery: a cross-sectional study of the IBD Genetics Consortium", Am J Gastroenterol, 108, pp.106~112 (2013)[DOI]
- Gathungu G, "Granulocytemacrophage colony-stimulating factor autoantibodies: a marker of aggressive Crohn's disease", Inflamm Bowel Dis, 19, pp.1671~1680 (2013)[DOI]