Digital disease management programme reduces chronic gastrointestinal symptoms among racially and socially vulnerable populations

Abstract

Objective: Considerable disparities exist in access to gastrointestinal (GI) care and digestive outcomes across gender, racial, and socioeconomic groups. We evaluated (1) whether adults with chronic GI symptoms from diverse demographic groups would use a digital digestive care programme and (2) the effects of participation on GI symptom severity and other patient-reported outcomes.

Methods: Access to a digital digestive chronic care programme was provided to participants regardless of prior digestive diagnoses or symptoms for 90 days. The intervention included GI symptom tracking, personalised medical nutrition therapy, GI-specific health coaching, and targeted education on common GI symptoms. We assigned a Social Vulnerability Index (SVI) score to each participant according to their home address and compared baseline and end-intervention symptoms and other patient-reported outcomes by gender, race/ethnicity, and SVI.

Results: Of the 1936 participants, mean age was 43.1 years; 67% identified as white/Caucasian, 11% Asian/Pacific Islander, 6% Hispanic/Latinx, 7% black/African American, and 7% of multiple races. Participants of all demographic groups used the app symptom logging, reviewed educational materials, and interacted with their care team and reported similar statistically significant improvements in GI symptoms (by the end of the intervention, 85% improved, p<0.05). Participants reported feeling greater control of their health (83%), better able to manage their digestive symptoms (83%), increased happiness (76%), and greater productivity at work (54%), with black/African Americans and Native Americans most likely to report these changes.

Conclusion: We conclude that a digital GI disease management programme may be of value in reducing disparities in access to GI care.

Keywords: ABDOMINAL PAIN; CHRONIC DIARRHOEA; CONSTIPATION; FUNCTIONAL BOWEL DISORDER; GASTROESOPHAGEAL REFLUX DISEASE.

Figure 1. Example recruiting materials/website.

Figure 2. Comparison of race/ethnicity of the study population, the US commercially insured population, and the overall US population.

Figure 3. Change in symptom severity by race and Social Vulnerability Index. The Social Vulnerability Index is a score from 0 (least vulnerable) to 1 (most vulnerable) that allows geographies to be directly compared based on 16 measures across four categories (eg, socioeconomic status, household characteristics, housing type).

Figure 4. Improvement in total symptom scores by race, gender, and Social Vulnerability Index. Error bars represent the 95% CI.