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Abstract

Individuals living with inflammatory bowel disease (IBD) require regular medical follow-up. Rural residents face barriers to accessing specialized IBD care. Virtual care may act as a solution to reduce such barriers. The COVID-19 pandemic increased the use of telephone care (TC) appointments in certain Canadian provinces. In this study, we measured satisfaction with TC among individuals with IBD in Saskatchewan, Canada, and explored the factors associated with TC satisfaction. A cross-sectional study was conducted in Saskatchewan among individuals with IBD through an online survey completed between December 2021 and April 2022. The survey included demographic questions and the Telephone Care Satisfaction Questionnaire (TCSQ). Factors associated with TC satisfaction were explored using ordinary least squares regressions with robust standard errors. Regression estimates and 95% confidence intervals (95% CI) were reported. Eighty-seven individuals with IBD participated in the survey; 54 (64.3%) had Crohn’s disease, 53 (61.6%) were women, 60 (69.8%) lived in urban centers, and 37 (43.5%) were between 41 and 59 years old. The mean satisfaction with TC was 5.70 (SD = 0.94) on a scale from 1.00 (low) to 7.00 (high). Individuals with IBD in rural Saskatchewan reported TC satisfaction scores that were 0.42 points (95% CI 0.03-0.83) higher than those living in urban areas, adjusted by medications for IBD, health care provider managing IBD, and perceived health-related quality of life and quality of care. In conclusion, individuals with IBD in Saskatchewan reported high levels of satisfaction with TC. Rural residence is associated with higher levels of TC satisfaction. This study could help promote the utilization of TC and improve access to specialized IBD care, especially among individuals living in rural areas.

Keywords

telephone care virtual care inflammatory bowel disease patient experience rural health

Introduction

Individuals living with inflammatory bowel disease (IBD), a chronic disorder of the gastrointestinal tract, often require regular access to and follow-up with specialized medical care.¹ However, some individuals with IBD, such as those residing in rural and remote areas, may face barriers in accessing this specialized care and may rely on primary care or other health care providers.^1
-3 Virtual care (VC) involves different types of remote interaction between a patient and a health care provider (including telemedicine, video conferencing, telemonitoring, and telephone care [TC]),^4,5 and could act as a solution to accessibility challenges to specialized care by reducing traveling time and costs, and increasing the comfort and efficiency of care.⁶ For example, a study from the western Canadian province of Saskatchewan explored the experiences of VC among persons living with IBD and gastroenterology care providers (GCPs) and reported that VC improved access to specialized care, increased flexibility in care delivery, and minimized health risks.⁷

We should note that access to health care refers to the alignment of personal, sociocultural, economic, and system-related factors that allow individuals, families, and communities to obtain timely, necessary, continuous, and satisfactory health services.⁸ In addition, health care accessibility refers to the consistent and organized provision of care, that is, geographically, financially, culturally, and functionally within easy reach of the entire community.⁸ Studies have shown that different forms of VC can improve both health access (by reducing travel and waiting time) and accessibility (by providing flexible, patient-centered follow-up care that accommodates different physical and logistic constraints), enhancing convenience, minimizing travel, and supporting continuity of care for individuals in rural and remote communities.^5
-7

The use of VC significantly increased during the coronavirus 2019 (COVID-19) pandemic worldwide.^7,9 This switch to VC included individuals with IBD and gastroenterologists who mostly offered in-person care before the COVID-19 pandemic.¹⁰ Research has shown that VC is as effective as in-person care in terms of quality of care (QOC) and health care outcomes.^7,11 QOC could be improved using VC, especially when limited in-person outpatient visits can be scheduled.^7,10

A type of VC that has significantly increased in certain regions during the last years is TC.^9,12 A study reported that increased TC use was helpful for IBD consultations globally and in Europe especially during the COVID-19 pandemic.⁹ Different chronic conditions have been managed through TC around the world. A survey completed among individuals with IBD reported a drop in in-person consultation from 75% pre-pandemic to 25% during the COVID-19 pandemic, with at least 50% of these visits being telephone consultations.¹³ A few studies have shown high satisfaction with TC among patients and physicians and researchers report that a remarkable proportion of individuals will consider TC appointments after the COVID-19 pandemic.^7,9,14

Several studies have evaluated the satisfaction of individuals living with IBD with VC, especially satisfaction with telehealth.^15
-17 For example, a study conducted among patients of 8 community-based gastroenterology practices across the United States of America reported a high level of satisfaction with the use of telehealth among individuals with IBD. Study participants also found in-person care to be similar to VC regarding QOC.^18,19 Individuals with IBD using VC have also reported greater quality of life, better disease outcomes, increased disease-related information, increased understanding of the plan of care, and fewer in-person clinic visits.^7,20,21 Similarly, a study conducted in Alberta among individuals living with IBD reported high satisfaction levels with VC; 84.3% of individuals with IBD were comfortable communicating with their physician using remote systems, 77.5% agreed that a virtual clinic was an acceptable way to receive health care services, 84.8% agreed they would use VC services again, and 82.6% agreed they were satisfied with the Telehealth system.²² In addition, some studies have identified demographic factors associated with high VC satisfaction, specifically with telemedicine. These factors included age (younger age group), gender (women), residence (rural), and level of education (higher education).^23,24 A study from the United States evaluating satisfaction with outpatient cardiology telehealth visits during the COVID-19 pandemic reported that patient convenience, travel distance (<10 miles), gender, younger age, and non-white ethnicity were correlated with greater patient satisfaction.²⁵

Despite the existence of studies evaluating patients’ satisfaction with different forms of VC, little is known about the factors associated with TC satisfaction among individuals living with IBD in Canada. Therefore, this study aimed to measure the satisfaction with TC among individuals with IBD in Saskatchewan, Canada, and explore the factors associated with TC satisfaction.

Methods

A cross-sectional study was conducted among individuals living with IBD utilizing TC through an online survey which assessed individuals’ satisfaction with TC. This study was carried out between December 1, 2021 and April 31, 2022, in Saskatchewan, a western Canadian province with a population of about 1.2 million people.²⁶ Individuals with IBD residing in Saskatchewan over the age of 18 years and seen by either an IBD nurse practitioner or a gastroenterologist in outpatient follow-up visits were invited to participate in the anonymous online survey. Study participants were required to have at least 1 TC visit with a GCP during the last year and a previous in-person visit. Four IBD GCPs supported the recruitment of study participants, 2 gastroenterologists based in Regina and 2 based in Saskatoon. All individuals with IBD scheduled to have either in-person or telephone appointments during the study recruitment period were invited to participate in the online survey. The administrative staff of these 4 GCP offices shared a letter of invitation to participate and a study poster with a link to the online questionnaire with eligible participants when their clinic appointments (either virtual or in person) were booked.

Survey data of individuals living with IBD were collected through SurveyMonkey^®. Informed consent was obtained from each participant. Participants were asked to review a consent form at the beginning of the survey. Completion and submission of the survey were taken as implied consent. Ethical approval was obtained from the University of Saskatchewan Ethics Board (Beh-REB 2704).

Questionnaires

We used the Telephone Care Satisfaction Questionnaire (TCSQ), a 16-item questionnaire with a 7-point Likert scale for evaluating TC satisfaction that has been previously validated among individuals living with IBD.¹⁴ The TCSQ has optimal internal reliability (α = .96) and evaluates 2 dimensions of TC satisfaction: Usefulness (α = .95) and Convenience (α = .90).¹⁴ TC Usefulness is the individual’s perception that TC works and has a positive effect on their health care, and TC Convenience is the perception of being able to use TC with comfort and little difficulty.¹⁴ Supplementary File 1 presents a copy of the TCSQ.

The TCSQ provides a standardized or summary score of TC satisfaction on a scale from 1.00 to 7.00 obtained after adding scored levels per item and dividing them by the total number of items on the scale. Summary scores for the 2 dimensions of the questionnaire, TC Usefulness and TC Convenience, can also be obtained.¹⁴ In this study, we considered the standardized score of TC satisfaction, as well as the levels of Usefulness and Convenience satisfaction, when exploring the factors associated with TC.

The QOC was measured using the Quality of Care Through the Patient’s Eyes-IBD (QUOTE-IBD), a validated questionnaire to measure the perceived QOC from the perspective of individuals living with IBD.^27,28 This questionnaire consists of 23 items (10 generic and 13 disease-specific items) relating to health care received and the health care system over the past year, providing QOC scores between 0 and 10.²⁸ The QUOTE-IBD scores were categorized above and below 9 considering that a score <9.0 indicates suboptimal QOC.²⁷ The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) was used to measure health-related quality of life (HRQOL). The SIBDQ is a valid and reliable questionnaire for evaluating HRQOL and its scores range from 10 (worst HRQOL) to 70 (optimum HRQOL).²⁹ The SIBDQ levels were divided above and below 50 for the multivariable analysis. The survey also included demographic questions (including gender, age, and place of residence) and disease-specific questions (type of IBD, years living with IBD, main provider managing IBD, IBD-related medications, etc). The place of residence was asked as living in a place with a population of <15 000 people (rural) or in a center with more than 15 000 people (urban). Urban areas could include the largest Saskatchewan centers like the cities of Regina and Saskatoon, as well as small urban centers with more than 15 000 inhabitants like Prince Albert, Moose Jaw, Swift Current, and Yorkton. In addition, we asked the study participants about their preference for in-person or virtual care (yes/no), as well as if they believed that their IBD has been controlled within the last year and if their current treatment was useful in controlling their IBD (yes/no). A copy of the demographic questionnaire is available in Supplementary File 2.

Data Analysis

Descriptive statistics such as frequencies, means, standard deviations, medians, and interquartile ranges (IQR, Q1, and Q3) were calculated from demographic characteristics of persons with IBD, as well as for the levels of TC satisfaction, QUOTE-IBD, and SIBDQ.

To evaluate the factors associated with the levels of TC satisfaction (ie, TCSQ summary scores as a continuous variable with values between 1.0 and 7.0), bivariate and multivariable linear regression models were run using ordinary least squares (OLS) with robust standard errors. First, bivariate analyses between each of the independent variables and the summary TC scores were conducted. Variables with P < .2 in the bivariate analysis were pre-selected for the multivariable analysis.³⁰ Observations with missing data were excluded from the multivariable analysis.

We built multivariable linear regression models to adjust the results by the variables that could be associated with the levels of TC satisfaction and used a manual backward method. We started by including all the pre-selected variables and sequentially removing the variables with the highest P values, one at a time, until those that were statistically significant remained in the model. Then, the effect of potential confounding variables not retained in the model was evaluated. Potential confounding variables were included in the final model if the variable produced a considerable change in the coefficients of other variables in the model; a difference in the unadjusted and adjusted model estimates of >20% was considered a confounding effect.^30,31

The factors associated with the levels of TC Usefulness and Convenience, the 2 dimensions of the TCSQ, were also evaluated using bivariate and multivariable regression models.

Regression coefficients with their corresponding 95% confidence intervals (95% CI) were reported. Statistical analyses were completed using the statistical software STATA version 17. The level of significance was set at α = .05.

Results

In total, 87 individuals living with IBD completed the online survey. Among the study participants, 64.3% (n = 54/84) had Crohn’s disease, 61.6% (n = 53/86) were women, and 69.8% (n = 60/86) lived in urban centers. Most of the study participants (43.5%) were between 41 and 59 years old (Table 1).

Table 1.

Descriptive Characteristics of the Sample of Individuals Living With Inflammatory Bowel Disease (n = 87).

Variables	n/mean	% (SD)
Gender^a
Women	53	61.6
Men	33	38.4
Age group^b
18-40 y	25	29.4
41-59 y	37	43.5
≥60 y	23	27.1
Place of residence^a
Urban center (population >15 000 people)	60	69.8
Rural center (population <15 000 people)	26	30.2
Location of their GCP^a
Saskatoon	56	65.1
Regina	29	33.7
Other	1	1.2
Type of disease^c
Crohn’s disease	54	64.3
Ulcerative colitis	28	33.3
Indeterminate colitis	2	2.4
Years living with IBD
≤5	15	17.2
6-10	38	43.7
≥11	34	39.1
Medications for IBD^a
Biologics, immunomodulators or both	53	61.6
5-ASA or 5-ASA and corticosteroids^d	25	29.7
None	8	9.3
Professionals managing IBD^a
A gastroenterologist only	54	62.8
GCPs (ie, a nurse practitioner and a gastroenterologist)	16	18.6
A family physician, a gastroenterologist, and other non-GCPs	16	18.6
Need to travel to see a GCP^a
Yes	56	65.1
No	30	34.9
How often the individual sees a GCP^a
1-6 mo	28	32.6
7-12 mo	50	58.1
13 mo or longer	8	9.3
IBD under control within the past 12 mo
Yes	58	67.4
No	28	32.6
Treatment is useful in controlling IBD^a
Yes	72	84.7
No	13	15.3
Appointment preference
In-person	19	21.8
No preference	36	41.4
Virtual	32	36.8
TCSQ score	5.70	0.94
TC Usefulness score	5.52	0.98
TC Convenience score	6.15	0.84
QUOTE-IBD score^c	8.96	1.70
SIBDQ score^c	48.14	13.02

GCPs = gastroenterology care providers; IBD = inflammatory bowel disease; QUOTE-IBD = Quality of Care Through the Patient’s Eyes-IBD (scale from 0 to 10); SIBDQ = Short Inflammatory Bowel Disease Questionnaire (scale from 10 to 70); TC = telephone care; TCSQ = Telephone Care Satisfaction Questionnaire (scale from 1.00 to 7.00).

One missing value.

Two missing values.

Three missing values.

This category includes 22 individuals taking 5-ASA only and 3 individuals taking both corticosteroids and 5-ASA.

The mean TCSQ score was 5.70 (SD = 0.94) on a scale from 1.00 to 7.00. By dimensions, the mean TC Usefulness was 5.52 (SD = 0.98) and the TC Convenience was 6.15 (SD = 0.84). Regarding the perceived QOC and HRQC, the mean levels of the QUOTE-IBD and SIBDQ, respectively, were 8.96 (SD = 1.70) and 48.14 (SD = 13.02; Table 1).

In the bivariate analysis (Table 2), the area of residence (rural vs urban: β = .47 [95% CI 0.09-0.85]), health care provider managing IBD (both a nurse practitioner and a gastroenterologist vs a gastroenterologist only: β = .44 [95% CI 0.01-0.87]), and HRQOL (SIBDQ score: β = .48 [95% CI 0.08-0.89]) were associated with the levels of TC satisfaction. Medications for IBD (P = .08), years living with IBD (P = .14), and QOC (P = .20) were variables not statistically significant in the bivariate analysis but were considered in the multivariable analysis.

Table 2.

Linear Regression Estimates of Factors Aassociated With Telephone Care Satisfaction Among Individuals Living With Inflammatory Bowel Disease.

Variables	Unadjusted β (95% CI)	Adjusted β (95% CI)
Gender
Men	−.14 (−0.55 to 0.27)
Women	Ref.
Place of residence
Rural	.47 (0.09 to 0.85)	.42 (0.03 to 0.81)
Urban	Ref.	Ref.
Age group (y)
≥60	−.20 (−0.70 to 0.30)
41-59	−.23 (−0.75 to 0.29)
18-40	Ref.
Type of IBD
Ulcerative colitis	.14 (−0.29 to 0.58)
Crohn’s disease	Ref.
Years living with IBD
≥11	.03 (−0.73 to 0.79)
6-10	.42 (−0.32 to 1.17)
≤5	Ref.
Medications for IBD
Biologics and/or IM	.66 (−0.02 to 1.34)	.52 (−0.19 to 1.22)
5-ASA or 5-ASA and corticosteroids	.67 (−0.10 to 1.44)	.54 (−0.28 to 1.35)
None	Ref.	Ref.
How often individual see a GCP
13 mo or longer	−.08 (−0.91 to 0.75)
7-12 mo	−.18 (−0.63 to 0.26)
1-6 mo	Ref.
Professionals managing IBD
GCPs	.44 (0.01 to 0.87)	.53 (0.06 to 1.00)
A family physician, a GCP, and other non-GCPs	−.30 (−0.89 to 0.29)	.06 (−0.43 to 0.54)
A gastroenterologist only	Ref.	Ref.
IBD under control in the last year
No	.03 (−0.41 to 0.47)
Yes	Ref.
Treatment is controlling IBD
No	−.12 (−0.74 to 0.50)
Yes	Ref.
SIBDQ
≥50	.48 (0.08 to 0.89)	.34 (−0.10 to 0.78)
<50	Ref.	Ref.
QUOTE-IBD
≥9	.33 (−0.16 to 0.82)	.24 (−0.15 to 0.63)
<9	Ref.	Ref.

Note. Bold values denote statistically significant results.

IM = immunomodulators; 5-ASA = 5-aminosalicylic acid; GCPs = gastroenterology care providers (ie, a nurse practitioner and a gastroenterologist); SIBDQ = Short Inflammatory Bowel Disease Questionnaire; QUOTE-IBD = Quality of Care Through the Patient’s Eyes-Inflammatory Bowel Disease.

The area of residence (rural vs urban) and the health care provider managing IBD were retained in the multivariable model. Medications for IBD, HQRL, and QOC were identified as confounders and included in the model.

Adjusting by health care provider managing IBD, medications for IBD, HRQOL, and QOC, we identified that individuals living with IBD in rural Saskatchewan reported TC satisfaction scores that were 0.42 points (95% CI 0.03-0.81) higher than those living in urban areas (Table 2). Health care provider managing IBD (P = .08), medications for IBD (P = .34), HRQOL (P = .13), and QOC (P = .22) were not statistically significant variables in the final model.

Factors Associated With TC Usefulness

Area of residence (rural vs urban, β = .56 [95% CI 0.13-0.98]) and HRQOL (SIBDQ score, β = .55 [95% CI 0.10-1.01]) were associated with TC Usefulness in the bivariate analysis (Table 3). Health care professionals managing IBD (P = .07), years lived with IBD (P = .15) and QOC (P = .20) were considered in the multivariable analysis.

Table 3.

Linear Regression Estimates of Factors Associated With the Dimensions of Telephone Care Satisfaction.

Dimension	Telephone care – Usefulness		Telephone care – Convenience
Variables	Unadjusted β (95% CI)	Adjusted β (95% CI)	Unadjusted β (95% CI)	Adjusted β (95% CI)
Gender
Men	−.17 (−0.63 to 0.30)		−.08 (−0.45 to 0.28)
Women	Ref.		Ref.
Place of residence
Rural	.56 (0.13 to 0.98)	.56 (0.13 to 0.99)	.28 (−0.07 to 0.63)	.24 (−0.10 to 0.58)
Urban	Ref.	Ref.	Ref.	Ref.
Age group (y)
≥60	−.22 (−0.76 to 0.32)		−.17 (−0.64 to 0.31)
41-59	−.29 (−0.85 to 0.28)		−.11 (−0.60 to 0.37)
18-40	Ref.		Ref.
Type of IBD
Ulcerative colitis	.23 (−0.24 to 0.71)		−.06 (−0.47 to 0.34)
Crohn’s disease	Ref.		Ref.
Years living with IBD
≥11	−.03 (−0.90 to 0.83)		.18 (−0.44 to 0.8)
6-10	.42 (−0.43 to 1.26)		.44 (−0.15 to 1.04)
≤5	Ref.		Ref.
Medications for IBD
Biologics and/or IM	.51 (−0.29 to 1.32)		.98 (0.35 to 1.61)	.88 (0.14-1.61)
5-ASA or 5-ASA and corticosteroids	.56 (−0.36 to 1.47)		.93 (0.26 to 1.61)	.90 (0.14-1.66)
None	Ref.		Ref.	Ref.
How often individual see a GCP
13 mo or longer	.09 (−0.75 to 0.92)		−.44 (−1.32 to 0.44)	−.25 (−0.98 to 0.49)
7-12 mo	−.10 (−0.63 to 0.42)		−.35 (−0.68 to 0.01)	−.27 (−0.64 to 0.11)
1-6 mo	Ref.		Ref.	Ref.
Professionals managing IBD
GCPs	.44 (−0.07 to 0.94)	.55 (0.03 to 1.07)	.43 (0.11 to 0.76)	.46 (0.11 to 0.82)
A family physician, a GCP, and other non-GCPs	−.33 (−0.98 to 0.32)	−.02 (−0.64 to 0.61)	−.24 (−0.81 to 0.32)	.03 (−0.44 to 0.50)
A gastroenterologist only	Ref.	Ref.	Ref.	Ref.
IBD under control in the last year
No	.03 (−0.46 to 0.52)		.04 (−0.37 to 0.45)
Yes	Ref.		Ref.
Treatment is controlling IBD
No	−.04 (−0.69 to 0.61)		−.29 (−0.93 to 0.35)
Yes	Ref.		Ref.
SIBDQ
≥50	.55 (0.10 to 1.01)	.47 (−0.01 to 0.94)	.33 (−0.04 to 0.69)	.15 (−0.21 to 0.51)
<50	Ref.	Ref.	Ref.	Ref.
QOUTE-IBD
≥9	.33 (−0.23 to 0.88)		.33 (−0.12 to 0.77)	.21 (−0.15 to 0.56)
<9	Ref.		Ref.	Ref.

Note. Bold values denote statistically significant results.

Variables retained in the final model after the multivariable analysis were the area of residence and HRQOL. The health care provider managing IBD was identified as a confounding variable and included in the final model.

Adjusting by health care provider managing IBD and HRQOL, individuals reported TC Usefulness was 0.56 points (95% CI 0.13-0.99) higher among individuals with IBD living in rural Saskatchewan than their urban counterparts (Table 3). Health care provider managing IBD (P = .05) and HRQOL (P = .09) were not statistically significant variables in the final regression model of TC Usefulness.

Factors Associated With TC Convenience

In the bivariate analysis, the medications taken for IBD (P = .01) and the health care professional managing IBD (P = .01) were associated with TC Convenience. Specifically, individuals taking biologics and/or IM (β = .98; 95% CI 0.35-1.61) and those taking 5-ASA with or without corticosteroids (β = .93; 95% CI 0.26-1.61) reported higher TC Convenience compared with patients not taking any medications for IBD. Also, individuals with IBD managed by both a nurse practitioner and a gastroenterologist reported higher TC Convenience compared with those managed by a gastroenterologist only (β = .43; 95% CI 0.11-0.76). Other variables considered in the model building included years lived with IBD (P = .20), QOC (P = .15), area of residence (P = .11), frequency of consultation (P = .10) and HRQOL (P = .08). Medication taken for IBD, area of residence, and health care professional managing IBD were retained in the final model. HRQOL, QOC, and frequency of consultation were identified as confounding variables and included in the final model.

Considering the area of residence, medications taken for IBD, HRQOL, QOC, and frequency of consultation, TC Convenience satisfaction was higher in the groups of individuals with IBD who were managed by both a nurse practitioner and a gastroenterologist reported TC Convenience satisfaction scores that were 0.46 points (95% CI 0.11-0.82) higher than those who were managed by only a gastroenterologist (Table 3). There were no other significant results in the TC Convenience final regression model of TC Convenience.

Discussion

This study identified that the area of residence was associated with the levels of TC satisfaction in the multivariable analysis. It was observed that individuals with IBD living in rural areas (population <15 000 people) reported TC satisfaction scores that were 0.42 points (95% CI 0.03-0.81) higher than those living in urban centers (population <15 000 people), after adjusting for health care provider managing IBD, medications taken for IBD, HRQOL, and QOC. The higher satisfaction levels with TC among rural residents could be because this form of VC could have a larger impact on saving time and travel costs for individuals residing in rural and remote communities than among those in urban centers.^7,32,33 This finding aligns with the results of the quantitative data that explored the experiences of virtual IBD care in Saskatchewan among persons living with IBD and GCPs who valued the convenience of VC for people in rural and remote communities.³³ Also, our findings can be contrasted with a national survey among United States households that reported that 88% and 84% of rural and urban participants, respectively, were satisfied with VC.³⁴ However, a study from British Columbia explored VC among rural and urban residents in the summer of 2021³⁵ and researchers did not find differences in VC satisfaction between the groups.³⁵

Previous studies have reported an association between VC satisfaction and demographic factors such as age and gender.^25,36 Women, individuals in the younger age group, and perception of convenience had different satisfaction with VC.^36,37 We considered these variables in our analysis but did not identify statistically significant results. Health care provider managing IBD was found to be a confounder in the relationship between TC satisfaction and QOL, as well as with the area of residence. Residents in rural areas living with IBD may experience barriers in accessing health care and depend on other health care providers, such as family doctors or surgeons, to manage their IBD which could lead to lower quality of life.^7,38,39 A low quality of life could also be linked to low TC satisfaction.⁴⁰

Our study also identified an association between rural residence and high levels of TC Usefulness. There are a few studies focused on evaluating the utilization of VC between rural and urban populations. For example, a Canadian study compared rural-urban utilization of telemedicine among patients in the Ontario Telemedicine Network.⁴¹ Telemedicine utilization in rural northern Ontario had higher annual rates than in urban southern Ontario. Even within Northern Ontario, rates of telemedicine use were higher in rural and less populated populations. Increased TC utilization levels of satisfaction among rural residents could also be attributed to the convenience of using this form of VC especially because they may no longer need to travel long distances to see a specialist.^42,43

It is important to note that a Canadian study in the province of Ontario measured the utilization of telemedicine in rural and urban populations among at-risk patient groups prior to and during the COVID-19 pandemic. Researchers reported that most telemedicine users resided in northern (rural) Ontario (71.1% in 2012 and 57.8% in 2016) before the COVID-19 pandemic, but telemedicine use grew more in urban populations and decreased in rural populations during the COVID-19 pandemic.⁴⁴ Other studies have also reported increased VC utilization among urban residents compared the rural residents.^35,44 Notwithstanding, these are reports specific to telemedicine, not all forms of VC.

TC Convenience was associated with the health care providers managing the IBD. Individuals managed by both a nurse practitioner and a gastroenterologist reported TC Convenience scores of 0.46 points (95% CI 0.11-0.82) higher than those whose IBD was managed by the gastroenterologist only. Considering that TC Convenience refers to being able to use TC with comfort and little effort, and the ability to communicate effectively with health care providers and save time while solving health issues,¹⁴ this finding could speak to how TC follow-up appointments are convenient for a person with IBD and could provide easier access to GCPs, including both gastroenterologists and IBD nurses. Indeed, researchers have identified that IBD nurses often effectively manage patient questions and concerns via telephone.⁴⁵

It is important to note that our sample included participants with Crohn’s disease (64.3%), ulcerative colitis (33.3%), and indeterminate colitis (2.4%; Table 1). While these numbers are close to the distribution of IBD types described in Saskatchewan,⁴⁶ the predominance of individuals with Crohn’s disease in the sample may have influenced our findings. Individuals with Crohn’s disease are frequently followed by gastroenterologists and IBD nurses.^3,7 This variation in provider involvement could partly explain the higher TC Convenience scores observed among participants managed collaboratively by an IBD nurse and a gastroenterologist.⁴⁵ Future studies could examine whether TC satisfaction varies by provider mix, disease type, and disease severity to better capture diverse experiences within IBD populations.

Regarding our study limitations, the small sample size may have affected the study power and may not fully represent all individuals with IBD. Further studies with larger sample sizes are required to identify more factors associated with TC satisfaction. In addition, we used a convenience sample (no sample size calculation was performed), which could limit the generalizability of the results and the possibility of having sample bias. There could be a potential selection bias; for example, individuals with IBD who may have strong opinions about TC (positive or negative) might have participated more thereby affecting the results. We cannot estimate the participation response rate given our recruitment process. However, we contrasted the demographic characteristics observed in our sample with those reported in a previous population-based study of the IBD prevalence in Saskatchewan.⁴⁶ There were no statistically significant differences between our sample and population data by age group (P = .14), gender (P = .10), and disease type (P = .09) distributions. We also compared the rural-urban distributions between our sample (30.2% rural and 69.8% urban) and the distribution reported in another population-based study from Saskatchewan (29.8% rural and 70.2% urban), and no statistically significant differences were observed (P = .94).³ In addition, there could have been recall bias since study participants had to answer events within the last year. Some study participants may have found it difficult to recall events and perceptions. Also, some participants did not respond to all survey questions, which could affect the study results. Furthermore, this study did not evaluate the existing barriers to TC or negative outcomes related to using this form of care. Subsequent studies could also focus on such aspects of the use of TC, and work with larger and randomly selected samples.

Conclusion

This study identified that individuals living with IBD in Saskatchewan reported high levels of satisfaction with TC. Rural residence is associated with high levels of TC satisfaction. Rural residence was also associated with high levels of TC usability. In addition, individuals whose IBD is managed by both a nurse practitioner and a gastroenterologist had higher levels of TC Convenience compared to those managed by a gastroenterologist only. It is important to note that these findings are specific to individuals with IBD receiving outpatient follow-up care with GCPs. This study could help in the promotion of TC utilization and improve access to specialized IBD care, especially among those living in rural areas. Future studies, including larger and more diverse IBD populations, are needed to explore how disease type and severity, and care models could influence satisfaction with TC and overall experience of individuals living with IBD.

Supplemental Material

sj-docx-1-inq-10.1177_00469580251411616 – Supplemental material for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada

Supplemental material, sj-docx-1-inq-10.1177_00469580251411616 for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada by Jermia Nehwa Foncham, Noelle Rohatinsky, Sharyle Fowler, Sanchit Bhasin, Shannon Boklaschuk, Tom Guzowski, Kendall Wicks, Mike Wicks, Tasbeen Akhtar Sheekha and Juan Nicolás Peña-Sánchez in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material

sj-docx-2-inq-10.1177_00469580251411616 – Supplemental material for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada

Supplemental material, sj-docx-2-inq-10.1177_00469580251411616 for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada by Jermia Nehwa Foncham, Noelle Rohatinsky, Sharyle Fowler, Sanchit Bhasin, Shannon Boklaschuk, Tom Guzowski, Kendall Wicks, Mike Wicks, Tasbeen Akhtar Sheekha and Juan Nicolás Peña-Sánchez in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Supplemental Material

sj-docx-3-inq-10.1177_00469580251411616 – Supplemental material for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada

Supplemental material, sj-docx-3-inq-10.1177_00469580251411616 for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada by Jermia Nehwa Foncham, Noelle Rohatinsky, Sharyle Fowler, Sanchit Bhasin, Shannon Boklaschuk, Tom Guzowski, Kendall Wicks, Mike Wicks, Tasbeen Akhtar Sheekha and Juan Nicolás Peña-Sánchez in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Footnotes

Acknowledgements

We thank the individuals who participated in the online survey. This study was part of the master’s thesis of Jermia Foncham.

ORCID iD

Juan Nicolás Peña-Sánchez

Ethical Considerations

Ethical approval was obtained from the University of Saskatchewan Ethics Board (Beh-REB 2704). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to Participate

Participants were asked to review a consent form at the beginning of the online survey. Completion and submission of the survey were taken as implied consent.

Author Contributions

J.N.F., N.R., S.F., and J.N.P.-S. designed the study and contributed to the drafting of the manuscript. J.N.F., T.A.S., and J.N.P.-S. completed the data analysis and interpreted the results. All authors contributed to the study conception, data interpretation, revisions to the manuscript for important intellectual content, and approved the final version for publication.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study received funding from the Saskatchewan Health Research Foundation (SHRF) Solutions Grant. In addition, the graduate student of the project received funding from the College of Medicine Graduate Award (CoMGRAD), University of Saskatchewan.

Declaration of Conflicting Interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: N.R. has received honoraria for speaking from Abbvie, Amgen, CANIBD. S.F. has received honoraria for speaking or consultancy from Abbvie, Janssen, Takeda, Pendopharm, Pfizer, Amgen, Sandoz, JAMP, Fresenius Kabi, and Celltrion. S.B. has received honoraria for speaking or consultancy from Jannseen, Abbvie, Takeda, and Pfizer. S.B. is also a board member of the Saskatchewan Medical Association. The other authors declare no conflict of interest.

Data Availability Statement

The datasets generated and analyzed during the current study are not publicly available due to protecting the privacy of the study participants, but are available from the corresponding author on reasonable request.

Supplemental Material

Supplemental material for this article is available online.

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Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

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Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan,Canada

Abstract

Keywords

Introduction

Methods

Questionnaires

Data Analysis

Results

Factors Associated With TC Usefulness

Factors Associated With TC Convenience

Discussion

Conclusion

Supplemental Material

sj-docx-1-inq-10.1177_00469580251411616 – Supplemental material for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada

Supplemental Material

sj-docx-2-inq-10.1177_00469580251411616 – Supplemental material for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada

Supplemental Material

sj-docx-3-inq-10.1177_00469580251411616 – Supplemental material for Rural Residence Is Associated With Telephone Care Satisfaction Among Individuals With Inflammatory Bowel Disease: Cross-Sectional Study From Saskatchewan, Canada

Footnotes

Acknowledgements

ORCID iD

Ethical Considerations

Consent to Participate

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

Supplemental Material

References

Supplementary Material