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Irritable Bowel Syndrome (IBS) is the most common functional gut disorder affecting approximately 5-12% of the Western population [1]. Despite this prevalence, only about 30% of IBS patients will consult a physician for their symptoms [2].
Background
The cost of care per year is a substantial burden for patients [3]. Digital health platforms offer a promising solution for patients to manage IBS at home with reduced economic impact. However, little is known about the role of health care providers in the use and successful facilitation of digital therapeutics.
Nerva app
The Nerva app is a 6-week gut-directed hypnotherapy program created by Dr. Simone Peters and Mindset Health. The app includes daily (15min) hypnotherapy sessions, psychoeducation readings, and breathing exercises.
Objective
The objectives of this study were to determine whether health care provider referral to the Nerva program would affect patient adherence and outcomes.
Methods: The data from 22,500 paid Nerva users was analyzed. The users were asked to complete the IBS-VAS questionnaire at the beginning of the program (week 0) and the end (week 6). Users were split into two groups: referred by a health care provider, or not referred by a health care provider. The groups were determined based on a question in the onboarding assessment where users are asked if they were referred by a health care provider. All users were paid users, and received the exact same program.
Results
There was a higher proportion of users who were not referred by a health care provider (n=21,136) compared to users referred by a health care provider (n=1,361). The proportion of users who completed the final session was significantly higher in the health care provider referred group compared to the not referred group (referred: n=505, 37%, not referred: n=5,159, 24.4%). The proportion of users who completed the symptom report prior to finishing the last session also was significantly higher in the referred group (referred: n=309, 22.7%, not referred: n=3,076, 14.5%). Finally, the proportion of users who saw overall GI symptom improvement based on the IBS-VAS was higher in the referred group compared to the not referred group (referred: n=241, 17.7%, not referred: n=2,521, 11.9%). 78% of the users referred by a health care provider who filled out the post-program questionnaire saw improvement. Users who were referred were 1.5x more likely to finish the program. 82% of the users not referred by a health care provider who filled out the post-program questionnaire saw improvement. However, these users were 1.5x less likely to finish the program compared to users who were referred by a health care provider. (Figure 1)
Discussion
This is a brief look into the role of a health care provider referral into patient success using a digital therapeutic. We found that patients who are referred are more likely to finish the program and see beneficial results. The findings suggest that patients who are referred by a health care provider are more accountable to the program and therefore see benefit in a greater proportion. Patients who are not referred are still seeing the same symptom improvement as those referred but are less likely to finish the program. There is more to understand regarding the role of the health care team in digital therapeutics, however, a simple referral can have lasting effects on the patient adherence and outcome.
