WHAT TO KNOW ABOUT TELEMEDICINE IF YOU HAVE ULCERATIVE COLITIS

The use of virtual healthcare visits has grown significantly in recent years, as many people find video chats or phone calls from home convenient, particularly when it comes to managing chronic conditions that require regular follow-ups.

Theres no doubt that telemed visits can be a great tool for both patients and physicians, says Robert Battat, MD, an inflammatory bowel disease (IBD) specialist and associate professor at the Universit de Montral. This is especially true for people with UC, who may need to see their GI doctor as often as every few weeks during a flare.

In relapse, symptoms flare up, and treatment access can be a little bit delayed with in-person consultation, because they need to get an appointment with the IBD specialist or gastroenterologist, says Suja Davis, RN, a professor at the School of Nursing at the University of North Carolina at Chapel Hill. Telemedicine can be appropriate, so they can consult with the provider at the earliest time to discuss worsening symptoms.

Here are five things to know about telehealth if you have UC.

1. You Can Get Access to Better Healthcare

Major urban centers have a disproportionate amount of specialists who subspecialize in specific diseases, such as UC, compared to rural areas, says Dr. Battat. We have patients who live many hours away, who were previously commuting in to see us. Telemedicine gives them access to some of the best healthcare without having to drive six hours. Its a huge advantage for these patients.

Additionally, people often have to see more than one specialist, such as a gastroenterologist, a registered dietitian, and a psychotherapist, to help treat UC, which makes a multi-hour drive a greater burden.

Section chief of gastroenterology and hepatology Corey Siegel, MD, and his team at Dartmouth Hitchcock Medical Center in New Hampshire developed RADIUS, which stands forRural APPs (advanced practice providers) Delivering IBD Care in the United States, to combat this issue. The program connects people with IBD to the specialists they need via telehealth.

Having a nurse coordinator, a pharmacist, a dietitian, and behavioral health specialists like psychologists are really important, says Dr. Siegel. What would be ideal for people is if they can see the whole team all at once. And why not do it over telemedicine?

The program currently serves people in Colorado, Idaho, Maine, Montana, New Hampshire, New Mexico, Oregon, Tennessee, Vermont, Washington, and Wyoming, with more sites to be added in the future.

2. You Can Lower Your Infection Risk

By opting for a telemedicine visit, people with IBD can avoid a trip to the doctors office, where they might be exposed to illness-causing viruses, bacteria, or other microbes. If you dont have to expose yourself [to pathogens], then dont, says Dr. Chachu.

3. Digital Messaging Allows You to Communicate With Your Doctor More Often

In addition to signing on to your appointments using an online portal, youre usually able to message your providers through the same website or app, allowing you to avoid playing phone tag. People can ask their healthcare providers questions about medications, symptoms, and upcoming visits not to mention go over important lab and test results anytime, via patient portals.

I always want patients to know whats going on, says Chachu. When we do routine labs or colonoscopies, for example, I make sure to send those to patients with a little message that says, Your labs are normal, or whatever it may be. I always want my patients to feel like theyre part of the decision-making process, and telemedicine allows that.

Battat also uses patient portals to share healthcare records and test results with newcomers before their appointment. It really helps the doctor know his or her patient much better when theres a back-and-forth, he says.

But Davis says that this rapport often needs to be established by meeting with doctors in person initially.

Any patient-provider relationship for the first few consultations should be face to face, to know that someone validates your concerns and the person will trust you, Davis says. Once they establish that relationship and the patients symptoms are under control, telemedicine could be the more appropriate path.

4. You Can Use Telemedicine to Build a Strong(er) Rapport With Your Doctor

Both Battat and Chachu say that combining in-person visits with telemedicine visits and the use of patient portals usually allows you and your doctor to communicate with each other more effectively.

Its great to have access to both [virtual and in-person appointments], as they each provide different options for patients, says Battat.

Siegel says that video technology has also highlighted another aspect of IBD treatment rarely seen in a doctor's office.

An eye-opening part of telehealth to me was that theres something valuable about seeing patients in their own home, Siegel says. Seeing them in their home environment, [such as] an older adult who isnt very mobile or a young mom with four or five kids running around screaming, [highlights] different aspects of their lives that I think play into how we best understand our patients.

5. You May Still Need to See a Doctor in Person

While doctors can diagnose and treat many conditions via telemedicine, people with UC may need to go into the office at times. If theres something that seems new or bigger, or if a patient has a lot of abdominal pain thats different or more severe, its best to schedule an in-person visit with your GI doctor, says Chachu.

If theres a perianal issue, which is often the case with a UC patient, she adds, its difficult and also uncomfortable to try and get a camera on that area. Its not only easier but also more effective at that point to see a physician in person.

Davis says that determining an initial diagnosis may be easier with in-person appointments.

I feel like a face-to-face consultation is more individualized, and patients can walk a little more through the specific symptoms, Davis says.

Finally, Chachu says that telemedicine shouldnt be your first choice in an emergency. Think of patient portals and telemedicine as something with business hours, she says. A healthcare provider [usually] wont return your messages until the next business day, so if its a true emergency, go to the emergency room.

The Takeaway

• Telemedicine has become more commonly offered, and it can be a good option for people with chronic conditions like ulcerative colitis that require regular follow-up appointments.
• Virtual visits can increase access to healthcare for people living in areas without many providers, decrease infection risk, and make getting answers to questions easier (especially via digital messaging), among other benefits.
• There are some scenarios that will still require in-person visits, including emergency care.

Additional reporting by Zachary Smith.