PHILADELPHIA—An electronic stool diary app for patients using a vibrating capsule for treatment of chronic idiopathic constipation may improve compliance with therapy and result in improved outcomes, according to the first community-based assessment of real-world experience in patients using the novel therapy.
“Generally, what happens when our patients are prescribed treatment for anything, whether it be constipation, reflux disease, what have you, at the end of the day, we have no feedback on whether or not they’re benefiting from their therapy and if that influences their choice of treatment,” investigator Satish Rao, MD, told Gastroenterology & Endoscopy News.
“The way companies monitor compliance is by seeing if patients prescribed a treatment are refilling it, but we have no direct knowledge of what’s happening on the patient end,” he explained.
To assess the impact of feedback on bowel symptoms and patient compliance, Dr. Rao, a professor of medicine at Augusta University Medical Center, in Georgia, and his co-investigators invited 1,075 patients prescribed vibrating capsule therapy to download an app to record five bowel-related metrics: bowel movement frequency, complete spontaneous bowel movement, stool consistency, straining effort and time spent on the toilet. The researchers compared patients who used the app with those who did not.
Presenting the results at ACG 2024 (abstract P4074), Dr. Rao reported that of the 453 (42%) of patients who downloaded the app, 58 (13%) used it for eight or more weeks of treatment. These patients were two times more likely to order a refill compared with those who did not use the app (68% vs. 34%; P<0.0001). Those in the app-using cohort also reported significant improvements in all bowel symptoms from the baseline established in the first week of treatment.
Dr. Rao said he suspects that positive feedback from the app—trackable evidence that a patient’s symptoms are improving—motivates patients to stay adherent to therapy by giving them a clearer understanding of how they are doing than they would have relying on memory alone. This accuracy benefits both the patient and their physician.
“For people who have a daily bowel habit, it’s very clear that, say, yesterday, they didn’t have a bowel movement. But when people have chronic constipation, recall of bowel habit is very poor. Did they have two or three bowel movements this week? Or none?” Dr. Rao said. “So if their doctor asks how often they have a bowel movement, they guess an answer. Chronicling their bowel movements in a prospective stool diary is the best way for them to inform a healthcare provider of the exact state of their bowel function.”
Brian Lacy, PhD, MD, a professor of medicine at Mayo Clinic in Florida, Jacksonville, said it would be interesting to know why 58% of patients did not download the app. “Was it lack of interest? A problem with the technology? Was the smartphone setup not easy to understand? Digging through those questions would be useful.”
But he said he found it encouraging that although younger patients were more likely to download and use the app, a significant number of patients 65 years of age and older (36%) did so, too. “I believe it is a misconception that older patients are uncomfortable or unfamiliar with using smartphones and apps,” he said. “We have used apps in some of our research projects, and many of our patients in their 70s and even 80s feel quite comfortable downloading and using apps on their smartphones.”
This point may be especially salient, given the increasing prevalence of gastroenterology research studies using apps to record data, Dr. Lacy said, pointing to a recent meta-analysis that found nine randomized controlled trials assessing the use of apps in patients taking medication for a variety of health conditions. The review concluded that apps may support patient adherence to treatment (BMJ Open 2020;10[1]:e032045).
“It is hard for everyone to remember to take pills or stick to a diet or exercise routine. Simply logging in to an app is a nice and easy reminder about symptoms and symptom responses,” Dr. Lacy said. “This is an important message and may help other researchers with future studies. Apps may increase patient compliance. That’s a good thing.”
—Monica J. Smith
Dr. Lacy reported financial relationships with AbbVie, Ardelyx, Gemelli Biotech, Ironwood, Salix and Takeda. Dr. Rao eported financial relationships with Ironwood and Palette Life Sciences. He is a member of the Gastroenterology & Endoscopy News editorial board.
link to original article: https://www.gastroendonews.com/PRN/Article/01-25/Vibrating-Capsule-Constipation-Therapy-App/75946
