Sara Horst, MD, on Telemedicine for IBD Care

Dr Horst reviews how the use of telemedicine has become a game-changer in enabling access to care for patients with inflammatory bowel disease, especially since the COVID pandemic.

Sara N Horst, MD, MPH, is an associate professor of medicine and assistant chief for clinical informatics in the Division of Gastroenterology, Hepatology, and Nutrition at Vanderbilt University in Nashville, Tennessee.

Hi, I'm Sara Horst. I'm a gastroenterologist at Vanderbilt University Medical Center, and I specialize in the care of patients with inflammatory bowel disease. I also am our ambulatory medical director for telehealth. And I recently put these two roles together and presented some work that we've done at our center around telehealth in the care of patients with inflammatory bowel disease and presented this data recently at AIBD as a poster and are really continuing our work in this area.

So I think that taking care of patients via telehealth, especially patients with chronic disease, such as inflammatory bowel disease, has been a game changer over the past few years since the COVID pandemic. And before the COVID pandemic, there were rather significant restrictions around how patients could get access to telehealth because of insurance restrictions and things like that. They really couldn't do it very easily in a way we call direct-to-patient or the patient could be at home while the clinician is in clinic. But since the pandemic, this has really opened up.

And we wanted to look at our experience at our center because we have a large catchment area. We take care of patients routinely who are 3 or 4 hours away. And we wanted to see what happened after the pandemic and how if we could continue to give high quality care for patients with inflammatory bowel disease via telehealth. So we looked at our experience and within our clinic, we really offer a wide range of telehealth services for patients, particularly patients who are seeing us in follow-up, and they really have access to our clinicians, our pharmacists, our mental health providers, and in some cases, our dietitians.

And so in looking at the behavior of patients before the pandemic, when they really didn't have much access to telehealth and after, we found that we were able to retain patients, so keep patients in our multidisciplinary clinic, 10% more in the era of telehealth, meaning that patients could continue to see us, especially if they were complex, via telehealth and really maintain that access. Not everyone needs access to, you know, continued multidisciplinary care, but a lot of patients are quite complex, so we're able to show this.

We also showed that we were retaining patients who were driving routinely 2 hours to 3 hours away 10% of the time more for people who lived 2 hours away, 13% more of the time for people who lived 3-plus hours away. So again, just showing that that telehealth is offering continued care for patients who may be a significant way away from a multidisciplinary care team.

The other thing we showed in a subset of patients, because one of the questions that I get asked a lot as well, can you continue to give as good or better care via telehealth for patients with inflammatory bowel disease than you can in clinical settings. And we looked at a subset of patients where we had access to all of their health records, including all emergency department visits in the hospitalizations as well as clinic visits. And we saw that patients who had had at least one telehealth visit continuing compared to patients who were only seen in clinics, they actually had lower rates of emergency department visits and hospitalization. So we do think that we, you know, this is a surrogate marker, but we think that, you know, continuing care via telehealth in the right patient population can actually lead to better access, continued access, and does not decrease high quality care for patients with inflammatory bowel disease. So we're really excited about this data.

And I think one of the most important parts that we did that I forgot to mention was, when we looked, 60% of our patients in the postpandemic period had had at least one telehealth visit with us. So we're doing this a lot and these patients are continuing to have good access to our team. So we hope to continue to expand this data and continue to advocate for telehealth for patients with chronic disease.

Thanks.