Telemedicine Hybrid Care Models in Gastroenterology Outpatient Care: Results from a German Tertiary Center

Abstract

Background: With the COVID-19 pandemic, a rapid adoption of telemedicine became necessary. Data regarding its implementation in specialized hepatology/IBD care remain limited. This study evaluated telemedicine's effectiveness and safety during the pandemic at a German tertiary center and explored its integration into future hybrid care models. Methods: In a retrospective study, we analyzed 3147 patient encounters at the outpatient clinic of the Department for Gastroenterology and Hepatology at the University Hospital Frankfurt between March and June 2020. We assessed patient characteristics, appointment adherence, and outcomes across the three specialized clinics: hepatology (n = 1963), liver transplant (n = 594), and IBD (n = 590). Multivariate regression analysis identified predictors of successful telemedicine utilization. Results: Out of all appointments, 1112 (35.3%) were conducted via telemedicine, with significantly different adoption rates across clinics (hepatology, 40.4%; liver transplant, 32.8%; IBD, 21.0%, p < 0.01). Adherence rates were comparable between telemedicine (91.3%) and in-person visits (90.5%). Multivariate analysis identified age (OR 1.009, 95%CI 1.004-1.014, p < 0.001), metabolic-associated steatotic liver disease (OR 1.737, 95%CI 1.400-2.155, p < 0.001), and post-liver transplant status (OR 1.281, 95%CI 1.001-1.641, p = 0.049) as independent predictors of successful telemedicine utilization. HBV/HDV coinfection (OR 0.370, 95%CI 0.192-0.711, p = 0.003) and required endoscopy (OR 0.464, 95%CI 0.342-0.630, p < 0.001) were associated with in-person care. Hospitalization rates were low and comparable across modalities, confirming telemedicine's safety. Conclusions: This study demonstrates that telemedicine can be successfully implemented in specialized gastroenterology and hepatology care, with high compliance rates comparable to in-person visits. Patient characteristics and disease-specific factors influence the suitability for telemedicine, supporting a stratified approach to hybrid care models, which can optimize resource utilization while maintaining quality of care. Particularly stable MASLD patients, well-controlled post-transplant recipients beyond one year, and IBD patients in sustained remission can be properly managed through telemedicine with annual in-person assessments.

Keywords: hybrid care; pandemic; telemedicine.

Figure 1

Flow diagram showing the selection process from initial appointments through physician determination of visit modality. Appointment modality was based on clinical assessment.

Figure 2

Telemedicine utilization by primary diagnosis. Abbreviations: MASLD: metabolic-associated steatotic liver disease, AIH: autoimmune hepatitis, PBC/PSC: primary biliary/primary sclerosing cholangitis, LTX: liver transplant, UC: ulcerative colitis, and HBV/HDV: hepatitis B/D virus coinfection.

Figure 3

Appointment compliance rates by specialty and visit type. Abbreviations: AIH: autoimmune hepatitis, IBD: inflammatory bowel disease, UC: ulcerative colitis. * Indicates statistically significant differences (p < 0.05) between in-person and telemedicine compliance rates.