Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California, USA.
Department of Medicine, University of California Davis, Sacramento, California, USA.
Am J Gastroenterol. 2022 Jan 1;117(1):78-97. doi: 10.14309/ajg.0000000000001545.
Digital health technologies may be useful tools in the management of chronic diseases. We performed a systematic review of digital health interventions in the management of patients with inflammatory bowel diseases (IBD) and evaluated its impact on (i) disease activity monitoring, (ii) treatment adherence, (iii) quality of life (QoL) measures, and/or (iv) health care utilization.
Through a systematic review of multiple databases through August 31, 2020, we identified randomized controlled trials in patients with IBD comparing digital health technologies vs standard of care (SoC) for clinical management and monitoring and reporting impact on IBD disease activity, treatment adherence, QoL, and/or health care utilization or cost-effectiveness. We performed critical qualitative synthesis of the evidence supporting digital health interventions in patients with IBD and rated certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation.
Overall, we included 14 randomized controlled trials (median, 98 patients; range 34-909 patients; follow-up <12 months) that compared web-based interventions, mobile applications, and different telemedicine platforms with SoC (clinic-based encounters). Although overall disease activity and risk of relapse were comparable between digital health technologies and SoC (very low certainty of evidence), digital health interventions were associated with lower rate of health care utilization and health care costs (low certainty of evidence). Digital health interventions did not significantly improve patients' QoL and treatment adherence compared with SoC (very low certainty of evidence). Trials may have intrinsic selection bias due to nature of digital interventions.
Digital health technologies may be effective in decreasing health care utilization and costs, though may not offer advantage in reducing risk of relapse, QoL, and improving treatment adherence in patients with IBD. These techniques may offer value-based care for population health management.
数字健康技术可能是慢性病管理的有用工具。我们对管理炎症性肠病（IBD）患者的数字健康干预措施进行了系统评价，并评估了其对（i）疾病活动监测、（ii）治疗依从性、（iii）生活质量（QoL）措施和/或（iv）医疗保健利用的影响。
通过对截至 2020 年 8 月 31 日的多个数据库进行系统评价，我们确定了比较数字健康技术与 IBD 患者标准护理（SoC）的临床试验，用于临床管理和监测，并报告对 IBD 疾病活动、治疗依从性、QoL 和/或医疗保健利用或成本效益的影响。我们对支持 IBD 患者数字健康干预措施的证据进行了批判性定性综合，并使用推荐评估、制定和评估（Grading of Recommendations Assessment, Development and Evaluation）对证据的确定性进行了评级。
总体而言，我们纳入了 14 项随机对照试验（中位数，98 例患者；范围 34-909 例患者；随访<12 个月），比较了基于网络的干预措施、移动应用程序和不同的远程医疗平台与 SoC（基于诊所的就诊）。尽管数字健康技术与 SoC 之间的总体疾病活动和复发风险相当（证据确定性非常低），但数字健康干预措施与较低的医疗保健利用率和医疗保健成本相关（证据确定性低）。与 SoC 相比，数字健康干预措施并未显著改善患者的 QoL 和治疗依从性（证据确定性非常低）。由于数字干预措施的性质，试验可能存在内在选择偏倚。
数字健康技术可能有效减少医疗保健利用率和成本，尽管在降低 IBD 患者的复发风险、QoL 和改善治疗依从性方面可能没有优势。这些技术可能为人群健康管理提供基于价值的护理。
