Barriers to the use of a mobile and web-based application for tracking inflammatory bowel disease.

Abstract

PURPOSE: The GI Monitor (WellApps) is a novel mobile phone and web-based application that enables patients to utilize real-time, interactive, patient-controlled data entry to encourage patient-physician communication. There are emerging data that patients who are involved in participatory healthcare have improved outcomes, as well as improved adherence. Since 2009, we have enrolled 138 patients with inflammatory bowel disease (IBD) to use the application; however, only 30 patients (22%) have logged data at least 3 times, while only 10 patients (7%) have entered data consistently on a weekly basis. One hundred and eight patients (78%) were invited to use the application but never participated. Our goal was to conduct a survey to understand the reasons patients did not use this useful application. METHODS: One hundred and thirty-eight patients with ulcerative colitis or Crohn's disease were invited to use a mobile and web-based application that allows instantaneous subjective self-scoring at any time point to capture information on symptoms, quality of life, medication adherence, food intolerance, and missed work. A 10-question survey was used to query patients on their perceived benefit of using this technology and also to understand why they may have chosen not to participate at all. RESULTS: Thirty-seven of 138 patients (27%) responded to our survey. Of the 37 respondents, 13 patients (35%) said that they had trouble accessing a cell phone or computer for numerous reasons. Nine of 37 patients (24%) indicted time restraint was a factor, while 3 of 37 patients (8%) didn't understand how to log in symptoms and 2 of 37 patients (5%) were concerned about privacy issues. The remaining 9 of 37 patients (24%) had other reasons for not participating (ie, lack of perceived benefit, not wanting to be reminded about their disease, or no time to create an account). CONCLUSIONS: The best potential health outcomes can be achieved by linking the patient to his or her willing clinician. Understanding the behaviors of patients to predict participation in this partnership is one of the challenges of the 21st century. If incentives align and this goal is achieved, the mutual benefit will be of great value to the patients, providers, and healthcare system at large. Currently there are no financial incentives for clinicians, patients, or payors to adopt healthrelated applications. If the reimbursement system could structure payments based on outcomes, then this might encourage patient and provider involvement. Predicting patient nonadherence and effecting behavioral-change interventions, with incentives, is an ongoing project for the healthcare industry. Participatory health-related online or mobile tools, together with informed patients and a prepared and proactive healthcare team, will impact and improve IBD outcomes and allow patients to become more effective advocates in their own care.