S516 Virtual Visits for Initial Evaluation of Constipation Are Associated With Reduced Outpatient Order Compliance

Abstract

Methods: 15,552 patients with self-reported IBS downloaded a 42-session mobile app-delivered GDH program 'Nerva'. The first 7 sessions were free. Overall and individual gastrointestinal symptoms were assessed at baseline and 6 weeks after starting the program, using a 100-mm visual analogue scale (VAS). Psychological outcomes were measured using the PHQ4, which is validated to categorise likelihood psychological distress into normal (0-2), mild (3-5), moderate (6-8) and severe (9-12). Data were parametric and presented per protocol. Results: Out of 15,552 users, 3101 completed the program. Of those who completed the program, overall gastrointestinal symptoms improved by 28 mm, to a level that would be considered meaningful clinically (mean 67 mm to 39 mm; p, 0.001 t-test). In the those who did not complete the program, overall gastrointestinal symptoms still significantly improved, but to a smaller magnitude (68 mm to 58 mm). Similar results were seen with individual symptoms. Linear regression analysis indicated that users who completed the program were more likely to respond (p, 0.001). Total adherence rate was generally low, with only 20% of users completing the program. However, users who were referred to Nerva by a HCP were statistically more likely to complete the program (24%) compared with those self-referred (19%) (OR 1.3; p, 0.001 logistic regression). HCP referral did not alter gastrointestinal symptom response (p50.024). Users who completed the program were more likely to improve psychologically (mean Δ3, shifting from moderate to mild distress, vs 1, p, .001). Conclusion: App-delivered GDH improves overall and individual gastrointestinal symptoms. Users who complete the program report greater improvement in psychological outcomes. HCP referral is a positive predictor of program completion, but does not alter rates of efficacy.