Patient Automated Text Hovering for IBD
Condition: Inflammatory Bowel Diseases; Crohn Disease; Ulcerative Colitis
MeSH terms: Crohn Disease; Intestinal Diseases; Inflammatory Bowel Diseases
Study type: Interventional

Summary: 
      This is a 2-arm randomized trial aimed at leveraging behavioral science principles to improve
      patient engagement between office visits among patients with inflammatory bowel disease
      (IBD).
    

Detailed description: 
      Crohn's Disease (CD) and Ulcerative Colitis (UC), collectively known as inflammatory bowel
      disease (IBD), are common chronic gastrointestinal diseases with significant morbidity and
      decreased quality of life. Care for patients with IBD has been transformed by biologic
      therapies which dramatically improve inflammation and clinical outcomes. As they are
      delivered through infusion or injection with long intervals between doses, it can be
      challenging for patients to maintain adherence due to systems issues such as prior
      authorization and site of service limitations, in addition to traditional reasons for
      non-adherence such as inertia and present-time bias. Despite evidence that high adherence is
      needed for effectiveness, estimates are as low as 66%.

      Preliminary observations and interviews show that an important gap for providers is lack of
      knowledge of how their patients are doing between visits. Specifically, patients may not
      adhere to necessary therapy, and physicians are unaware of changes in course of the disease.
      A large cross-sectional study has shown that patient-reported outcomes are associated with
      control of the disease, but serially monitoring these measures has not been tested
      prospectively. A prior study found that assessing symptoms weekly is highly correlated with
      information collected with a more cumbersome daily diary. This may provide additional data to
      clinicians to better manage symptoms and therapy.

      Text messaging is an attractive tool to engage with patients due to the high prevalence of
      cell phones. The investigators will develop and test a new IBD hovering program that improves
      the care of patients between office visits. The investigators will enroll patients prescribed
      biologic therapy and provide text message reminders about scheduled infusions or injections
      that incorporate behavioral science principles such as anticipated regret, precommitment, and
      reciprocity. The investigators will also have the patient identify a friend or family member
      to serve as a support partner to encourage adherence and provide assistance as needed. The
      platform will communicate with patients weekly to ask about the course of their symptoms,
      send messaging to the feedback partner, and send alerts to physicians as needed.
    

Intervention name(s): Control; Text-based Clinical Hovering
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Subjects will engage with their providers as is standard of care.; Subjects will receive remote monitoring via text messaging of clinical symptoms and medication adherence reminders with feedback to social support.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Health Services Research
Keywords: Behavioral Economics; Patient Engagement; Remote Monitoring