JMIR Publications

ABSTRACT

Background:

Screening and intervention for alcohol use disorders (AUD) are recommended to improve alcohol-related liver disease (ALD) patient prognosis. Most patients’ smartphone application (app) diaries record drinking behavior for self-monitoring, but in most of the previous studies, physicians did not use such patient data in practice. Our idea is that a smartphone app is helpful not only for the patient but also for the physician, because it can provide rich patient information to hepatologists, leading to suitable feedback. To clarify the above, we designed both the patient app and the physician’s view, the latter contains graphic view of daily ethanol use during a treatment period. We conducted this prospective pilot study to assess the use of a smartphone app as a journaling tool and a self-report-based feedback source for ALD patients.

Objective:

The aims of this study were to assess whether journaling (self-report) and self-report-based feedback can help patients to maintain abstinence and to improve liver function data.

Methods:

This pilot study used a newly developed smartphone journaling app for patients, with input data that physicians can review. After ALD patients were screened for harmful alcohol use, some were invited to use the smartphone journaling app for 8 weeks. Their self-reported alcohol intake, symptoms, and laboratory data were recorded at entry, week 4, and week 8. Biomarkers for alcohol use included GGT, %CDT, and GGT-CDT [GGT-CDT= 0.8 × ln(GGT) + 1.3 × ln(%CDT)]. At each visit, their recorded data were reviewed by a hepatologist to evaluate changes in alcohol consumption, and laboratory data. The relation between those outcomes and app usage was also investigated.

Results:

Of 14 patients agreeing to participate, 10 completed an 8-week follow-up with diary input rates between 44% and 100% of expected days. Two withdrew from clinical follow-up. Two others never used the smartphone journaling app. Using the physician’s view, a treating hepatologist gave feedback comments to patients at each visit. Self-reported alcohol consumption dropped from baseline (100 ±70 g) to week 4 (13±25 g, P=.002) and remained lower to week 8 (13±23 g, P=.007). Five patients reported complete abstinence during the study. No significant change was found for GGT and %CDT alone, but the GGT-CDT combination dropped significantly from entry (5.2±1.2) to week 4 visit (4.8±1.1, P=.02) or to week 8 (4.8±1.0, P=.010). During the study period, decreases in total bilirubin (3.0±2.4 to 2.4±1.9 mg/dL, P=.014) and increases in serum albumin (3.0±0.9 to 3.3±0.8 g/dL, P=.009) were recorded.

Conclusions:

These pilot study findings revealed that the smartphone journaling app used by both patients and treating hepatologists produced short-term reduced drinking and liver function improvement.