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The PROMise of remote monitoring to improve quality of care for inflammatory bowel disease

M. de Jong

Inflammatory bowel diseases (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gastrointestinal tract characterised by periods of exacerbation and remission. The current treatment target for IBD is to achieve and maintain steroid-free clinical remission and to prevent structural bowel damage, such as fistulas, abscesses, intestinal strictures, and surgery. To achieve these targets, recent guidelines advocate more stringent management, involving tight control of disease activity and early intervention in patients with intestinal inflammation. Other interventions address aspects of inflammatory bowel disease that may influence disease activity, such as non-adherence to treatment, unfavourable nutritional status, smoking, and psychological factors. These personalised interventions were shown to reduce the rates of disease relapse, healthcare utilisation and absence from work in subsets of patients, but have not been systematically implemented in routine care. Implementing such a tight and personalised control strategy puts substantial pressure on patients’ time and the capacity of outpatient clinics and it remains challenging to acquire all necessary information at the right moment for each individual patient. Furthermore, the heterogeneous nature of inflammatory bowel disease, combined with an absence of adequate markers for patient stratification, leads to under- or overuse of resources and subsequent costs. In this regard, telemedicine systems are promising to aid healthcare workers in implementing a tight control strategy and optimise efficiency of care at the same time. Telemedicine systems which have been used to manage chronic diseases, such as congestive heart failure and chronic obstructive pulmonary disease, allow for the strict and instantaneous follow-up of health parameters and timely, personalised interventions. Moreover, these systems can provide tailored information based on each patient’s needs. This thesis focuses on telemedicine for IBD and describes the development of myIBDcoach, the first telemedicine system that monitors and registers disease activity in patients with all subtypes of inflammatory bowel disease.