What to Know About Telemedicine if You Have Ulcerative Colitis

The COVID-19 pandemic forced many people to trade their in-person doctors’ appointments for virtual visits, with 46 percent of people in the United States using telehealth to replace their canceled healthcare visits in 2020 versus 11 percent in 2019, according to a report by McKinsey and Company, a consulting firm.

While the pandemic has waned and people are comfortable returning to healthcare facilities, telehealth usage is continuing at a higher rate than pre-pandemic levels, per an updated version of the McKinsey report.

While in-person visits will almost certainly still be a major part of the U.S. healthcare system, many doctors are encouraging their patients to continue to use telehealth after the pandemic, as a way to complement their treatment plans.

“There’s no doubt that telemed visits can be a great tool for both patients and physicians,” says Robert Battat, MD, an IBD specialist and assistant attending physician at Weill Cornell Medicine in New York City. This is especially true for people with ulcerative colitis (UC), who may be taking immunosuppressive medications and need to see their GI doctor as often as every three 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, clinical assistant 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 ulcerative colitis.

1. You Can Get Access to Better Healthcare

About 1 in 4 people who live in rural parts of the United States say lack of access to good doctors and hospitals in the community is a major problem, according to a survey published in May 2018 by the Pew Research Center. (By comparison, only 18 percent of people living in urban areas and 9 percent in suburban areas said the same.)

“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. It’s a huge advantage for these patients.”

Additionally, people often have to see a team of specialists to help treat symptoms, which makes the 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 (Rural APPs [advanced practice provider] Delivering IBD Care in the United States) to combat this hassle. The program treats DHMC as the primary center connecting patients to specialists they need within a network that is available once they log into a telehealth appointment.

“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?”

While the program currently serves patients in Vermont, New Hampshire, and Maine, it will be expanding to Oregon, Colorado, and Tennessee in the near future.

Telemedicine also allows access to those who may otherwise have difficulty securing or affording appointments.

Out of any race or ethnicity group, Black patients utilized telehealth options the most in the four weeks before being surveyed, at 26.8 percent of the group, compared with white patients, who used the technology the least at 21.1 percent, according to a February 2022 survey from the U.S. Department of Health and Human Services.

The same survey found that people with less than a high school education, those who made less than $34,000 in household income, those on Medicare or Medicaid, and those ages 65 or older were most likely to use telemedicine.

2. You Can Avoid Germs

Many people with ulcerative colitis take a type of medication called an immunomodulator. These medications work very well for “a high percentage of IBD patients,” explains Karen Chachu, MD, an assistant professor of medicine in gastroenterology, with a specialty in IBD, at Duke University School of Medicine in Durham, North Carolina. But they can also suppress the immune system and increase the risk of infection.

By opting for a telemedicine visit, people with IBD can avoid a trip to the doctor’s office, where they might be exposed to illness-causing germs. “If you don’t have to expose yourself [to germs], then don’t,” says Dr. Chachu.

3. You Might Be Able to Communicate With Your Doctor More Often

Doctors are sometimes too busy to jump on a phone call with their patients right away. With telemedicine, people can ask their healthcare providers questions about medications, symptoms, and upcoming visits — not to mention go over important lab and test results — via patient portals anytime.

“I always want patients to know what’s 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 they’re part of the decision-making process, and telemedicine allows that.”

This is a particularly good thing for people with ulcerative colitis. According to a study published in the journal The Lancet, people with IBD who used patient portals to monitor their symptoms had fewer outpatient visits and hospital admissions than those who didn’t use telemedicine.

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

But Davis says this rapport may come after initially meeting with doctors in person.

“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 patient's symptoms are under control, telemedicine could be the more appropriate path.”

4. You Can Use Telemedicine to Build a Strong(er) Patient-Doctor Rapport

Don’t underestimate the importance of a good relationship with your doctor. When patients have good communication with their doctors, they’re especially likely to stick with their treatments and be more satisfied with their care, according to a review published in 2010 in The Ochsner Journal. If the communication between patient and doctor is poor, the patient can feel disheartened and may be less likely to stick with their treatment plan.

For people with IBD, in particular, a study published in February 2022 in Gastroenterology found that trust was critical in three categories during telemedicine visits — trust in providers, trust in the institution, and trust in the surgical process. Of these, provider-level trust appeared to be the most influential.

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

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

Siegel says 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 there's something valuable about seeing patients in their own home,” Siegel says. “Seeing them in their home environment, an older adult who isn't very mobile or a young mom with four or five kids running around screaming are 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 ulcerative colitis may need to go into the office. “If there’s something that seems new or bigger, or if a patient has a lot of abdominal pain that’s different or more severe, it’s best to schedule an in-person visit with your GI doctor,” says Chachu.

“If there’s a perianal issue, which is often the case with a UC patient,” she adds, “it’s difficult and also uncomfortable to try and get a camera on that area. It’s not only easier but also more effective at that point to see a physician in person.”

Davis adds that initial diagnosis may benefit from 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 said. “Whereas telemedicine tools are a little more broad, so the provider needs to be specific to make sure that to check if a person is okay.”

Finally, Chachu says that telemedicine shouldn’t be your first choice in an emergency. “Think of patient portals and telemedicine as something with business hours,” she says. “A healthcare provider [usually] won’t return your messages until the next business day, so if it’s a true emergency, go to the emergency room.”

Additional reporting by Zachary Smith.