Gastrointestinal Guidelines app: Streamlining guideline awareness and adherence in gastroenterology

Gastrointestinal (GI) disorders are a major health concern, with millions of people affected each year worldwide1, 2 To ensure the best possible care for patients, clinicians must stay up to date with the latest multidisciplinary GI guidelines. However, with the sheer volume of guidelines available, it can be challenging for clinicians to keep track of them all. To address this issue, the United European Gastroenterology (UEG) Quality of Care (QOC) committee designed a tool aimed to provide easy access to high-quality available guidelines pertaining to all fields of GI care in an interactive way to better address everyday clinical challenges on the go, namely the GI Guidelines app (Figure 1). To date, the app has reached more than 25.000 downloads, providing 109 interactive tools and 34 guidelines (t.ly/_sC0). Between October 2022 and January 2023, a survey was sent out aiming to investigate (1) whether clinicians are aware of the currently available guidelines, (2) if the use of the interactive algorithms, calculators, and app functionalities were useful for the user during clinical practice, and (3) how to further improve the app with users' suggestions3 (Table 1). Gastrointestinal (GI) Guidelines app. The GI guidelines app has been downloaded over 25,000 times and offers 109 interactive tools and 34 comprehensive guidelines. A survey conducted between Oct 2022 and Jan 2023 revealed that the app helped increase awareness of guidelines among users. Approximately 11% of app users were not familiar with any of the included guidelines, highlighting the app's potential in increasing knowledge on guidelines. The app was rated highly in terms of usability, with 62% of users accessing it daily or weekly. Interactive algorithms, recommendation summaries, score calculators, and full-text access to guidelines were identified as the most useful components of the app. The UEG QOC committee, supported by eminent members of UEG affiliated International Societies, designed the GI Guidelines app and selected the initial guidelines to be included. The app provides easy access to guidelines and recommendations in the field of gastroenterology (https://ueg.eu/quality-of-care/search-guidelines/gi-guidelines-app). The included guidelines cover gastroenterology, endoscopy, hepatobiliary, neurogastroenterology, esophagus, pediatrics, pancreas, nutrition, surgery, and many more. Full-text versions of guidelines with bookmark and note functions, visual abstracts depicting the key messages of the guidelines, executive summaries of the most important recommendations of each guideline, interactive diagnosis and treatment algorithms, scores, and calculators are among the most innovative tools, all in one place. The survey was designed to investigate the usefulness and implications of the UEG GI application. The set of questions was aimed at users to gather information on their familiarity with the guidelines, adherence to the guidelines in clinical practice, app usage, and usability. Finally, suggestions from app users on how to improve the app and what guidelines they would like to see included were collected. The questions were selected and approved by the UEG QOC committee The survey was distributed through two channels: a pop-up in the guidelines app (in-app survey) and a link shared via email newsletter and social media (non-app survey). The non-app survey was aimed at non-users and users who were not using the guidelines app at the time of the survey. The survey was open from 28 October 2022 to 2 January 2023. App users who participated in the survey were asked to select up to three guidelines that they were familiar with. The complete survey is displayed in Supplementary Table 1. A total of 277 complete surveys were collected in-app, and 1557 (1046 users and 511 non-users) were in the non-app channel. After excluding incomplete surveys and duplicates, 1377 surveys were eligible for analysis (257 surveys from the in-app survey and 1120 from the non-app survey, including both non-users' and users' responses). The largest proportion of responders was in the 30–39 age range (37%, n = 506), followed by 18–29 (13%, n = 175), 40–49 (21%, n = 296), 50–59 (16%, n = 215), and >60 (10%, n = 136). In terms of training status, 65% (n = 891) of responders reported being fully trained, while 32% (n = 437) were in training, and 3% (n = 49) did not specify their status. The years of practice ranged from 0 to 57, with a mean of 13 and a median of 10. The geographic distribution of responders was from Europe (62%, n = 850), followed by Asia (16%, n = 217), Africa (9%, n = 118), America (9%, n = 127), and Oceania (1%, n = 16) (Figure 2). Demographic characteristics of users. Among the app users, 975 (71%) reported the use of the GI Guidelines app during daily clinical practice. Out of 2830 mentions, almost 11% (103/967) of respondents stated that they were not familiar with any of the guidelines listed. Among the app users, 62% (n = 585) reported using it on a daily or weekly basis (47%, n = 442 weekly, and 15%, n = 143 daily), whereas 30% (n = 282) reported using the app occasionally (monthly), 6% (n = 57) rarely (several times a year), and only 2% (n = 21) stated they never used it. In terms of usability, when asked how easy it was to find what they were looking for in the app, the mean rating was 76.56 (SD 17.6) and the median was 80 (IQR 21.5, 0–100), indicating that the app is perceived as user-friendly and easy to navigate. Interactive algorithms, summaries of recommendations, score calculators, and full text guidelines, represent the most useful components of the app. However, users recommended including more guidelines, adding verbal commands, and search filters by the publishing society to improve the app. In the non-app user group, responses from 402 participants were received, of whom 355 (88%) claimed to use guidelines in their clinical practice, while 47 (12%) stated that they do not. Interestingly, 173 (43%) of the non-app users reported being unfamiliar with any of the displayed guidelines. Almost 60% (250/402) of non-users did not know about the app, while 5% (21/402) did not find the most relevant guidelines in it. Results from 1377 responders show that the GI Guidelines app helped increase the visibility of high-quality multidisciplinary guidelines since 11% of users didn't know about any of the included guidelines. Interestingly, 43% of non-users did not know about any of the guidelines included, which underlines the potential of the GI guidelines app to increase knowledge on guidelines in all GI areas of care. The GI Guidelines app could play a significant role in improving guideline adherence in clinical practice by offering easy access to high-quality guidelines. This is reflected by the fact that half of the app users reported using the app frequently within their clinical practice, and 15% reported using it very frequently. The survey effectively identified the gaps, and users' suggestions that may need to be addressed, including improvements to the app. Our results may imply that this tool could increase physicians' awareness of existing guidelines, which is a step forward to better standardization and implementation in everyday clinical practice. Mobile apps (such as the iCyst or ECCO app)3 offer significant benefits to clinicians in gastroenterology, enabling them to enhance patient care, boost efficiency, facilitate communication, and alleviate stress. These apps provide access to up-to-date information, diagnostic tools, patient records, and treatment guidelines, thereby enabling clinicians to deliver improved care. One aspect of particular importance, that might represent a positive bias, is the median age of the responders. Half of them were indeed below the age of 30, providing interesting insights about the GI specialists of today and tomorrow. This is of course the subset of practitioners who are mostly exposed to digital tools. However, investing in such a cohort of professionals is crucial to shaping the future of GI medicine and clinical practice. To ensure that the content of the app remains up-to-date and relevant to clinicians' needs, user feedback and engagement will be incorporated into the app. This will help identify areas for improvement and prioritize updates. The GI Guidelines app has been downloaded over 25,000 times and offers 109 interactive tools and 34 comprehensive guidelines. It is highly regarded by users, as reflected by excellent ratings. The survey results affirm the positive impact of the GI Guidelines app in increasing the awareness of guidelines among users and highlight its potential to improve guideline adherence in clinical practice. The app's most popular features include interactive algorithms, recommendation summaries, score calculators, and access to the full text of guidelines. This app serves as a valuable resource to enhance clinicians' awareness and adherence to guidelines. In the future, the UEG and the UEG QOC committee will continue to update the app, making it easier for clinicians to access high-quality resources that can contribute to the improvement of clinical practice. Committee and task force members past and present: Stavros A. Antoniou, Livia Archibugi, Sorin T. Barbu, Doron Boltin, Stéphanie O Breukink, Francesco Maria Carrano, Markus Cornberg, Pieter-Jan Cuyle, Egle Dieninyte-Misiune, Glen A Doherty, Triantafyllos Doulias, Monika Ferlitsch, Thomas Gruenberger, Doenja Lambregts, Fernando Magro, Juan Mendive, Johann Ockenga, Iago Rodríguez-Lago, Jonas Rosendahl, Jordi Serra, Vita Skuja, Andreas Sturm, Eric Trepo, Riccardo Troncone, Carolynne Vaizey; we want to thank all specialist member societies for helping and supporting the GI Guidelines app: EAES, EAGEN, EASL, ECCO, EDS, EFISDS, EHMSG, EPC, ESCP, ESDO, ESGAR, ESGE, ESNM, ESP, ESPCG, ESPEN, ESPGHAN, EFSUMB. Alberto Balduzzi, Maarten te Groen, Ian Mark Gralnek, Wafaa Khannoussi, and Giovanni Marchegiani have no conflicts of interest to declare. European Union-NextGenerationEU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, Grant/Award Number: BG-RRP-2.004-0009-C02. Data sharing is not applicable to this article as no new data were created or analyzed in this study. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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