Traditionally, IBD clinics have been run via face-to-face consultations. However, over the last decade, the integration of telemedicine into clinical care has gained momentum and the Covid pandemic has led many healthcare providers to consider alternative modalities for service provision.

IBD mobile apps have been highlighted as an underused alternative to monitor and manage IBD [1]. Interestingly, it has been suggested that services that incorporate telemedicine systems into their model of care will be more patient-oriented and save costs [1], creating a win-win situation.

There are currently a number of IBD specific mobile apps available including IBDsmart, which was developed and tested right here in New Zealand, by researchers at the University of Otago Dunedin and Christchurch as well as the Waitemata DHB. IBDsmart was designed to allow healthcare providers and patients to monitor disease activity via well-tested questionnaires, namely the Harvey Bradshaw Index (HBI) [2] for patients with Crohn’s Disease or the Simple Clinical Colitis Index (SCCAI) [3] for patients with Ulcerative Colitis. The Crohn’s Disease Activity Index (CDAI) [4] can also be completed via IBDsmart, which is required as part of the Special Authority application for biological treatments.

In practice, once signed up to IBDsmart, the user receives notifications on a regular basis prompting them to complete the disease activity questionnaire via the app. The notification interval can be adjusted at any time, as well as other details, such as diagnosis and weight. Upon questionnaire completion, the user’s answers are translated into a report, which is sent to the IBD healthcare team for review. Actions that may be taken in response include, deferral of an appointment if the patient is well, sending a request for a blood test or an invitation to a face-to-face consultation. IBDsmart also offers a ‘Report a Flare’ button, which allows patients to make contact with their IBD healthcare team if they suspect active disease. In addition, IBDsmart features a free text box and instructional pictures and videos. 

IBDsmart was formally tested in a research study, which included participants from Canterbury, Waitemata and Hutt Valley District Health Boards. This study tested IBDsmart in conjunction with the use of another IBD specific mobile app called IBDoc, which requires patients to test their faecal calprotectin (measure of intestinal inflammation). The results showed that both mobile apps were acceptable, usable and non-inferior [5]. Furthermore, participants who had access to the apps had less face-to face appointments without showing an increased need for IBD related surgical appointments or IBD related hospital stays [5]. To find out more about this particular study, click on this link: https://academic.oup.com/ibdjournal/article/26/7/1098/5603780

Although the app was developed as a self-directed monitoring tool, it can also be used whenever the completion of the HBI, SCCAI or CDAI is indicated, e.g. prior to an appointment. Tablets could be handed to patients in the waiting room, allowing them to log on to their IBDsmart account to complete the HBI, SCCAI or CDAI.

In summary, IBDsmart has some great benefits:

• Symptoms can be monitored remotely, reducing the need for face-to-face consultations, especially for stable patients.
• Patients can quickly and easily report a flare of symptoms, facilitating prompt assessment and treatment.
• It allows patients to communicate with their IBD healthcare team and leave notes in the comment box, which could also be used for requesting prescriptions.

If you are a patient with IBD under the care of a gastroenterologist and you are interested in using the app, please speak to your IBD healthcare provider to find out if they are offering IBDsmart.

If you are an IBD healthcare provider and would like to use IBDsmart in your service, please contact us on ibdsmart@otago.ac.nz. We are happy to help you getting set up.

References

1. Lees, C.W., et al., Innovation in Inflammatory Bowel Disease Care During the COVID-19 Pandemic: Results of a Global Telemedicine Survey by the International Organization for the Study of Inflammatory Bowel Disease. Gastroenterology, 2020. 159(3): p. 805-808 e1.

2. Harvey, R.F. and J.M. Bradshaw, A simple index of Crohn's-disease activity. Lancet, 1980. 1(8167): p. 514.

3. Walmsley, R.S., et al., A simple clinical colitis activity index. Gut, 1998. 43(1): p. 29-32.

4. Best, W.R., et al., Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology, 1976. 70(3): p. 439-44.

5. McCombie, A., et al., A Noninferiority Randomized Clinical Trial of the Use of the Smartphone-Based Health Applications IBDsmart and IBDoc in the Care of Inflammatory Bowel Disease Patients. Inflamm Bowel Dis, 2020. 26(7): p. 1098-1109.