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Abstract
Introduction The need for directed self-are is fundamental to the safe management of chronic diseases such as IBD, which is characterised by a relapsing and remitting course. Access to timely assessment and modification of treatment is essential during IBD flares to avoid the need for hospitalisation. Similarly, scheduled care models may cause significant disruption to activities of daily living and work for patients
IBD Home is a whole system model is comprehensive, integrated, and holistic approach to value-based care to provide `multidisciplinary ring` of supported care around the needs of patients where possible in their own homes. Electronic- and virtual-based platforms have been developed to routinely monitor IBD patients and guide appropriate interventions. We incorporated a patient-facing app called MyIBD Care® and CalproSmart™ self-calprotectin test in two cohorts of patients participating in IBD Home in the IBD unit at hull university teaching hospitals
Methods Eligible IBD patients were invited to participate in the project. We piloted two cohorts of patients in this phase – cohort 1: patients in long-term remission on no therapies/and or mezalazine compounds. Cohort 2: Patients on self-administered biologics or immunomodulatory agents. Following consent to digital data sharing and training, home FC results and patient reported the patient in patient portal of My IBD Care App. entered Outcome Measures (PROMS). The interval of PROMS and frequency of home calprotectin tests were personalised to the cohort. IBD care navigator reviewed the information and those with raised calprotectin was reviewed virtually by IBD nurse in the clinician portal with a bidirectional record of the contact. The primary outcome
Results 1382 patients were eligible and invited to participate the two cohorts (29.5% of the entire Hull IBD cohort). Five hundred and ninety four patients (43%) joined cohort (284 in cohort 1 and 310 in cohort 2). 550 patients (total number of PROMS 2309, mean 4.25) completed PROM. PROM engagement is depicted in figure 1. One hundred and forty seven patients had an intermediate or high calprotectin results among whom 94 had symptoms suggestive of flare on PROMs. In patients with elevated home calprotectin test 42 needed in person appointment and 24 others had change in therapy. One hundred and eleven patients in cohort 1 did not require an annual clinic review because of PROM result and low calprotectin levels. At 12 months, 41 patients (6.9%) were withdrawn from the cohorts.
Conclusion Patient initiated follow up using My IBD care app along with self-monitoring of calprotectin is feasible in IBD patients in long-term remission and may reduce in person appointment. In those who join, the engagement to the PROM completion and continuation in pathway remains high at 12 months s at 12 months Identification of suitability and studying patient preferences is important to increase uptake rates in digital pathways.
Acknowledgements This project was funded by NHS digital health partnership award