Informing Modern Models of Care: A Randomized, Sequential Trial of In-Person, Telehealth, and Telephone Appointments for Patients with Inflammatory Bowel Disease.

Abstract

Background: A significant shift toward virtual care has occurred for many patients with inflammatory bowel disease (IBD). To date, there are no prospective studies assessing patients visits across different styles of appointments.

Methods: We randomized IBD patients' appointments to in-person, video-assisted virtual, or telephone and subsequent appointments to the alternate style of visit in a single-center study in Victoria, Canada. Participants completed surveys after each appointment. Demographic data were collected and average scores were analyzed for potential associations.

Results: Forty-one patients were randomized to appointments, and 86 post-appointment surveys were completed, 30 in-person, 29 telephone, and 27 telehealth. The average age was 46.5 ± 18 years and 59% were female. The overall patient score (out of ten) by appointment type was 9.1 ± 1.0 for in-person, 7.8 ± 2.1 for telephone, and 8.0 ± 2.6 for telehealth without a statistically significant difference. While there was only a near statistically significant preference for in-person appointments compared with telehealth p = 0.055, it was statistically significant when comparing with phone appointments p = 0.014. The highest rated factors for preference of an in-person appointment were optimal communication and interaction with care provider (86%). For patients who preferred telehealth or telephone appointments, the highest rated factors were time and cost savings (71%, 43% and 58%, 33%, respectively). In-person appointments were associated with a significantly higher cost (p < 0.01), and longer time commitment.

Conclusions: Despite the increased cost and time commitment, in-person appointments were highly rated particularly in comparison to phone appointments. Based on this research, providers can be better informed on factors contributing to patients' preferred appointment style.