Smartphone apps for IBD patients plagued by shortcomings

Last Updated: 2018-06-27

By Scott Baltic

NEW YORK (Reuters Health) - Most smartphone apps aimed at patients with inflammatory bowel disease (IBD) have severe shortcomings, including a lack of scientific support and clinical validation, researchers say.

In a review of 56 mobile health (mHealth) apps for Apple and Android smartphones, they found such limitations to be common, despite widespread interest by IBD patients in receiving information via apps and/or social media.

"There is a substantial opportunity to educate, engage, and self-empower IBD patients using mHealth applications," Dr. Linda A. Feagins of Dallas VA Medical Center, in Texas, told Reuters Health by email, especially "given the younger age of onset of IBD compared to other chronic illnesses."

Although IBD patients are willing to turn to the internet and mHealth apps for information, support and self-management tools, she added, "There is a significant lack of physician involvement in the design, implementation, and assessment of these resources, particularly in mHealth apps."

Dr. Feagins and her colleague Dr. Michael Kelso found 25 Android apps, 15 iOS apps, and 16 Android/iOS apps for English speakers available through either Google Play or Apple's iTunes App Store.

The researchers also searched the literature to identify a handful of apps that are available only to patients at various healthcare systems, such as the University of California, Los Angeles Center for IBD and Mount Sinai Hospital in New York.

In general, they write in Inflammatory Bowel Diseases, online June 4, multiple barriers will have to be addressed before mHealth apps can become more widely used in IBD management. Among these challenges are a lack of medical involvement in app design and questionable validity and accuracy of the apps' content.

Fewer than 10% of the apps focus on providing diagnostic tools, remote consultation and chronic-disease management tools, such as questionnaires, symptom scores, side-effect reporting and self-management recommendations, Dr. Feagins told Reuters Health.

Integration with electronic medical records, HIPAA-compliant messaging and privacy and security features to protect personal health information are often lacking, too.

The authors also point to a "concordance gap" between what patients want from an app and what gastroenterologists prioritize. "Physicians may not endorse tools that patients use, and patients may not find it necessary or beneficial to complete symptom and nutrition diaries or fill out symptom diaries," they write.

"Moreover, even if patients are actively engaged in mobile health app use, their physician must similarly be engaged in using the app," Drs. Feagins and Kelso write. "Otherwise, not only will there be a missed opportunity to gather additional data about a patient's current disease status, but critical information regarding a patient's health may go ignored, causing possible harm to the patient."

Dr. Feagins outlined her advice to clinicians or IBD patients about choosing an app.

First, patients should "look for apps that have been designed with physician involvement and published by academic medical centers, GI societies or similar organizations (and) that provide up-to-date and accurate educational materials, disease self-management tools, and allow transmission of data or interaction between the patient and provider."

Apps that incorporate support groups or online forums are also useful for information and psychosocial support, she added, but these "should be facilitated and moderated by health professionals."

Other valuable features include remote monitoring and symptom logs, push notifications/reminders that can improve treatment adherence, and supplementary educational materials that can be tailored to individual patients.

An editorial by Dr. Ashish Atreja of Mount Sinai School of Medicine, in New York, notes an issue similar to the concordance gap, in that apps that are primarily patient-facing might be free and be widely adopted, yet might have limited value beyond patient education or social support.

"Every app is not equal," he told Reuters Health in a phone interview. "Anyone can publish an app."

Like the authors, Dr. Atreja sees substantial value in apps that could allow remote monitoring of patient symptoms. He also points out that remote monitoring now can in some circumstances qualify for Medicare reimbursement.

The authors disclosed no conflicts of interest and no funding sources.

SOURCE: https://bit.ly/2N459oG and https://bit.ly/2MpBIfo

Inflamm Bowel Dis 2018.