Telehealth Pathway for IBD Surgery Expanded Access to Care in Small Study

ORLANDO — Utilization of a “total telemedicine pathway” for inflammatory bowel disease (IBD) surgery saved a considerable amount of mileage and time for patients treated at an academic IBD center, according to a small study presented here.

For 13 included patients, using telemedicine for all preoperative and postoperative visits saved a total of 6,195 driving miles, representing 116 driving hours, reported Gabriel Marrero-Rivera, MD, of the University of Pittsburgh Medical Center, at the Advances in Inflammatory Bowel Diseases annual meeting.

“TTP [total telemedicine pathway] for IBD surgical patients, particularly when coupled with existing IBD virtual care, can expand access to multidisciplinary IBD expertise, while increasing convenience and with positive environmental impact saving driving miles — especially for those in rural communities,” the researchers concluded in their poster.

Gaurav Syal, MD, MS, of the University of California Los Angeles, told MedPage Today that he found this approach interesting, given that telemedicine care in IBD has thus far “generally been limited to routine office visits with gastroenterologists, surgeons, or affiliated healthcare providers like dietitians, pharmacists, and psychologists.” However, he agreed that healthcare access can present challenges.

“Many IBD patients with complex IBD are best managed by gastroenterologists and surgeons who specialize in IBD. However, most patients who live in the community unfortunately don’t have easy access to such specialists,” Syal said. “It is well established that lack of access to appropriate medical/surgical care leads to poor health outcomes across disease states.”

“Hence, expanding the access to specialty services can not only reduce the burden of travel on patients but also improve outcomes in IBD,” he added. “In fact, the use of telemedicine in IBD care that accelerated during the COVID-19 pandemic has been well received by patients and providers alike.”

The study authors pointed to the rapid increase in use of telemedicine for IBD care during the pandemic and research suggesting that telemedicine care is associated with high patient satisfaction levels and no increase in IBD-related hospitalizations.

Ali Rezaie, MD, of the Gastrointestinal Motility Program at Cedars-Sinai in Los Angeles, told MedPage Today that he also saw the potential value for improving access.

“Medical specialist access, especially in rural or underserved areas, remains a significant issue, and telemedicine is a reasonable solution,” Rezaie said. “This approach is likely more cost-effective as well. Formal cost-effective analyses can help advocate for better insurance reimbursement for telemedicine services.”

Though Syal acknowledged the potential benefits of this total telemedicine pathway approach, he also expressed some reservations about it.

“For preoperative and postoperative evaluations, surgeons and anesthesiologists obtain critical information by physically examining the patients’ abdomen — the field of surgery — and their general physical condition, which can have a significant impact on their perioperative outcomes,” Syal said. “Lack of this can potentially lead to incomplete evaluation and increase the risk of perioperative complications. Similarly, inspection of the surgical wound after surgery is best done in person.”

Syal also highlighted the better connection that can be established between patient and provider through in-person appointments. “This is particularly important when patients are referred for surgery and they meet a surgeon who they have never met before,” Syal said. “In such situations, an in-person visit can go a long way in building the patient’s trust in the surgeon.”

The total telemedicine pathway pilot program began in February 2023, and this study reported on 13 IBD patients who underwent surgery from March to November 2023. Mean age was 41, and most patients were men (n=10). One patient had ulcerative colitis and the rest had Crohn’s disease. Nine patients underwent ileocecal resection, two underwent a colectomy, and two underwent a proctectomy. None of the patients experienced major adverse events.

Patients lived an average of 101 miles and a median of 46 miles from the academic IBD center, with an average of 118 minutes and a median of 68 minutes driving time.

The program used telemedicine for the surgery consultation that addressed risks, benefits, and the surgical approach; the preoperative anesthesia clearance visit; and post-surgical care and follow-up visits.

Patients had an average of one preoperative visit with anesthesia, an average of 1.23 preoperative visits with surgery, and an average of 1.2 telemedicine preoperative visits within 6 months of surgery.

Ten patients had at least one IBD telemedicine preoperative visit within 6 months of surgery, and nine had at least one postoperative visit within 6 months of surgery. The average number of IBD telemedicine postoperative visits within 6 months of surgery was an average of 1.22, and the total number of months of postoperative follow-up was an average of 13.07 months.

Syal noted that the study did not evaluate the impact of telemedicine IBD surgical care on patient satisfaction or on effectiveness and safety outcomes, including perioperative complications, all of which need further evaluation before the model is applied more widely, he said.

Rezaie offered similar cautions. “Ensuring that virtual evaluations, such as anesthesia clearance, are as effective as in-person assessments is critical,” he said. “The program must be rigorously evaluated for clinical outcomes and patient safety. When it comes to logistics, cost, and insurance coverage, I have minimal concerns, as these challenges have largely been addressed since the rise of virtual medicine during the COVID era.”

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