Can digital health revolutionize IBD management?

Digital health technologies (DHTs) can help lower healthcare utilization and costs but appear to have not enough juice to reduce the risk of relapse, improve quality of life (QoL), and increase treatment adherence in patients with inflammatory bowel disease (IBD), according to a study.

On the other hand, “[t]hese techniques may offer value-based care for population health management,” the researchers said.

A systematic review of multiple databases was performed through 31 August 2020 to evaluate the impact of DHTs on disease activity monitoring, treatment adherence, QoL measures, and healthcare utilization or cost-effectiveness. Randomized controlled trials (RCTs) in IBD patients comparing DHTs with standard of care (SoC) were identified.

The researchers also carried out critical qualitative synthesis of the evidence supporting digital health interventions in patients with IBD and rated certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation.

Fourteen RCTs (median, 98 patients; range 34‒909; follow-up <12 months) comparing web-based interventions, mobile applications, and different telemedicine platforms with SoC (clinic-based encounters) were included in the study.

The overall disease activity and risk of relapse were similar between DHTs and SoC (very low certainty evidence), but digital health interventions resulted in reduced rate of healthcare costs and utilization (low certainty evidence). [Am J Clin Gastroenterol 2022;117:78-97]

However, digital health interventions fell short of significantly improving patients’ QoL and treatment adherence relative to SoC (very low certainty evidence). In addition, RCTs might have intrinsic selection bias due to the nature of digital interventions.

These findings were consistent with a previous systematic review, which reported that DHTs (eg, web-based interventions, virtual clinics, smartphone applications, and telemedicine) could promote self-management and reduce the impact of the growing burden of IBD on healthcare resource use. [J Crohns Colitis 2016;10:1103-1121]

In another study, patients have notably expressed willingness to engage with eHealth as a “potential solution to facilitate IBD self-management.” Their most preferred DHTs were smartphone apps and internet websites. [Scand J Gastroenterol 2017;52:973-980]

“Future development and testing of eHealth solutions should be informed by all major stakeholders including patients to maximize their uptake and efficacy to facilitate IBD self-management,” the authors said.

Of note, a review by Yin and colleagues stressed the need for further validation and improvement of DHTs from a clinical and patient perspective despite earlier studies demonstrating that digital health interventions can “fit into, complement, and improve the standard clinical care of patients with IBD.” [J Med Internet Res 2019;21:e14630]

“Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge,” the authors said.

“New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses,” they added.