Remote clinical assessment of inflammatory bowel disease using smartphone applications

Abstract

INTRODUCTION Inflammatory bowel disease (IBD) is a chronic, relapsing disease requiring ongoing monitoring. Smartphone applications will allow remote monitoring of a large geographical catchment of Waitematā District Health Board (WDHB). IBDSmart (Otago University/Gut Health Network) is a phone application for patients to self-report flares and monitor disease using validated scoring systems. IBDSmart has been shown to be non-inferior to standard care and to reduce face-to-face appointments. IBD-Disk® provides validated visual representation of Quality of Life (QoL), allowing for patient-centred discussions in clinic and tracking QoL with treatment. The aim of this study was to understand if these applications are feasible in the outpatient setting in terms of patient/clinician feedback and validity of patient’s scores. METHODS IBD patients attending WDHB gastroenterology clinics were recruited over the phone, emailed brochures, and asked to complete IBDSmart/IBD-Disk® surveys one to two weeks before their appointments. Clinicians were provided with Harvey Bradshaw Index (HBI)/ Simple Clinical Colitis Activity Index (SCCAI) at appointment and reminded to discuss IBD-Disk® responses. Feedback was collected using five-point scoring of five affirmative statements. RESULTS Eighty-four participants were contacted; 45 used IBDSmart and 10 used IBD-Disk®. Nine clinicians were involved. There were technical issues; IBDSmart links expired within 48hours, and IBD-Disk® does not work in Android Operating Systems 9.0–11.0. The majority (≥60%) of participants and clinicians either completely agreed or agreed with statements. Correlation between clinician and patient scores was moderate (R2 for HBI 0.52, for SCCAI 0.49). CONCLUSIONS Both applications are highly useable and accepted by patients and clinicians. However, technological issues need to be addressed. Correlation of scores could be improved through increased patient education and application design.