At Ampersand Health, we recently concluded a service evaluation exploring the effectiveness of My IBD Care, a self-management app for patients with Inflammatory Bowel Disease (IBD).
In 2019, we were awarded an InnovateUK grant, which has enabled us to conduct this study, comprising over 300 adults across two large London centres (Barts Health NHS Trust, and King’s College Hospital NHS Foundation Trust). Ampersand’s co-founders, Dr Bu’ Hayee and Nader Alaghband, and IBD Lead Clinical Nurse Specialist at Barts Health NHS Trust, Ana Ibarra sat down with Dr James Somauroo, host of The Healthtech Podcast, to share their reflections on the service evaluation, as well as their vision for the future of digital therapeutics.
When we were awarded the Innovate UK grant in late 2019, our aim had been to conduct a Randomised Controlled Trial (RCT), comparing users of the My IBD Care App with a control group. RCTs have long been heralded as the gold-standard of Evidence-Based research, and we saw little reason to stray from the tried and tested. We’d prepared a robust protocol for our study, and had even secured ethical approval, ready to hit the ground running and start recruiting patients. And then Covid struck, scuppering our project before it had even begun. As the old adage goes, best laid plans…
It was at this point that we decided to do an about turn, and pivot towards a service evaluation rather than abandoning our study altogether. “In a way”, Ana adds, “Covid was the right time to evaluate our app”. With the cancellation of almost all face-to-face services, the pandemic had forced many healthcare providers to look at novel alternatives to traditional models of service delivery.
We recruited over 300 patients, aged predominantly between 18-45 (although we also had a sizeable number of older adults), with the only inclusion criteria being that their condition was stable. Although no longer an RCT, Bu’ points out, the team were committed to quantitative analysis and measuring hard endpoints. They settled on three main outcome measures: outpatient attendances, admission rates, and patient reported outcome measures (PROMs), which were then compared with baseline (or pre-app) data. We were pleased to find that across all three of these measures, the use of the My IBD Care App produced:
- An 89% reduction in episodes of unplanned care
- A 33% real world reduction in appointments
- A 14% clear saving in the cost of care
The service evaluation was not without its challenges. We saw generally good levels of engagement with the app, including with our older patients, which was encouraging given the concerns surrounding digital exclusion in certain demographics. In some ways, this has begun to herald a paradigm shift towards greater patient empowerment, and the rise of patient-initiated follow-up (or PIFU). Bu’ recalls a conversation he had with a young female patient of his with IBD. When informed about the deployment of the App, her first concern was whether she would continue to have access to her hospital team:
“On the contrary”, he reassured her, “now you can see me, when YOU want to see me.”
The group discussed where service evaluations should fit within the broader context of evidence-based research. Many clinicians are rightly drawn to the academic rigour of RCTs; it is, after all, difficult to draw conclusions in the absence of a control group. At the same time, there is increasing recognition that service evaluations offer a “real world” way to assess new treatment approaches, in particular for digital interventions that carry relatively little clinical risk.. Frontline health staff appreciate service evaluations and the evidence of real-world effectiveness, a welcome change from the controlled, constructed, and contrived world of RCTs often conducted among study populations vastly different from their actual patient populations. Ana memorably summaries this sentiment when she says:
“It didn’t feel like a study; I was just helping my patients”.
At Ampersand, we are committed to the self-management of many chronic conditions. The successful management of diseases such as IBD, Ana adds, rests upon patient education and empowerment, and yet too often, patients are kept in the dark about their illness. On this point, Bu’ observes the irony in patients being taught to self-inject their medication at the point of discharge in order to expedite their return home, only for anxieties surrounding self-injection leading to reattendance and readmission. Such readmission could be easily avoided if their fears were better allayed and condition better managed, at home and in the community.
Nader adds the rollout of patient self-management tools such as My IBD Care mustn’t add to the workload of an already over-extended clinical workforce. Instead, these tools have a role to play in building a sense of community, and promoting collaboration and engagement amongst chronic disease patients. He points to the many webinars and forums the Ampersand team have conducted to enable patients to interact with one another, plugging the gaps in their care that would be otherwise left unfilled.
Furthermore, Nader illustrates the example of under-treated symptoms such as chronic pain and fatigue, which adversely impact patients’ quality of life. He speaks to the potential of tools such as My IBD care in helping patients identify personalised strategies for coping, along with the support of a community of patients, subject matter experts and health coaches in addressing these parallel factors.
On their vision for the future, the trio are passionate about the ongoing rollout of My IBD care, as well as the growth of the digital therapeutics arena more broadly. Nader, Bu’ and the entire team at Ampersand are committed to finding ever more use cases that may be amenable to self-management, and care at home and in the community.
The full service evaluation report will follow soon. To find out more about Ampersand and the My IBD Care app, head to their website. To connect with Nader, Bu’, or Ana, you can reach out to them on LinkedIn.