chronic diseases: an app a day

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Presentation at the World Congress on Cardiology in Melbourne, Australia

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  • Managing Chronic Diseases: An App a Day? Iris Thiele Isip Tan MD, MSc @endocrine_witch #HealthXPh Chief, University of the Philippines Medical Informatics Unit Associate Professor, University of the Philippines College of Medicine Tuesday, May 6, 14
  • Disclosure Statement of Financial Interest I, Iris Thiele Isip Tan DO NOT have a nancial interest/arrangement or afliation with any healthcare related companies that could be perceived as a real or apparent conict of interest in the context of the subject of this presentation. Tuesday, May 6, 14
  • Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading causes of mortality in the world, representing 60% of all deaths. These diseases are preventable. Up to 80% of heart disease, stroke and type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. World Health Organization Tuesday, May 6, 14
  • Theres an app for that! Which app? Runkeeper and health on iPhone by Jason Howie, https://ic.kr/p/e5CBwN Apps (un)regulated The App Store by PhotoAtelier, https://ic.kr/p/9rCQw8 App Sketching by Johan Larsson, https://ic.kr/p/dHLKPt Tuesday, May 6, 14
  • Theres an app for that! Which app? Runkeeper and health on iPhone by Jason Howie, https://ic.kr/p/e5CBwN Apps (un)regulated The App Store by PhotoAtelier, https://ic.kr/p/9rCQw8 App Sketching by Johan Larsson, https://ic.kr/p/dHLKPt Tuesday, May 6, 14
  • Clinical uses for a medical app REFERENCE Clinician centered Patient centered EDUCATION Disease reference Clinical reference Drug reference Medical literature EHR & electronic prescribing Productivity Communication Medical calculator Health promotion Patient communication Health tracking Medication reminder General medical education Specialist medical education Formal continuing medical education Patient education Fig 1 from Aungst TD et al. Int J Clin Pract 2014;68:141-2. Tuesday, May 6, 14
  • Theres an App for That: Content Analysis of Paid Health and Fitness Apps West JH, Cougar Hall P, Hanson CL, Barnes MD, Giraud-Carrier C, Barrett J J Med Internet Res 2012;14(3):e72 n = 5430 Apps: Health and Fitness category n = 1324 Free apps (Excluded) n = 338 Non-English apps (Excluded) n = 432 Miscategorized into Health & Fitness category (Excluded) n = 3336 Final study sample 1 2 3 Assess credibility vs price Categorize content according to Health Education Curriculum Analysis Tool (HECAT) Categorize content according to Precede-Proceed Model (PPM) Tuesday, May 6, 14
  • Predisposing Factors Antecedents to behavior, such as knowledge, attitude, beliefs, values, and confidence or motivation. Enabling Factors Antecedents to facilitate behavior change such as teaching skills, providing a service, or tracking progress. Reinforcing Factors Factors that provide a reward or feedback for behavior, such as interaction with family, friends (social networks), or health professionals (trainer). Specic behavior by individuals Health Fig 1 from West JH et al. J Med Internet Res 2012;14(3):e72 Adapted from Precede-Proceed Model for health promotion planning and evaluation by Green & Kautner Causal relationship of Precede-Proceed Model factors inuencing behavior and health APPScan address one or more of these factors Tuesday, May 6, 14
  • App credibility by price West JH, Cougar Hall P, Hanson CL, Barnes MD, Giraud-Carrier C, Barrett J J Med Internet Res 2012;14(3):e72 This is an app intended to promote health or prevent disease This app is credible or trustworthy As a health care professional, I would use this app for my personal use or recommend it for use by one of my clients 0 500 1000 1500 2000 $0.99 >$0.99 No. of apps * * * * p 50% of apps achieving < 500 downloads 5 apps account for 15% of all downloads Tuesday, May 6, 14
  • Patient Apps for Improved Healthcare IMS Institute for Healthcare Informatics Oct 2013 n = 43,689 apps Healthcare & Fitness or Medical n = 20,007 Miscategorized or only loosely health related n = 23,682 Genuine healthcare related 1 2 3 App categorization IMS Health functionality scoring system Apps placement on the patient journey n = 16,275 Consumer oriented n = 7,407 Healthcare professional oriented Tuesday, May 6, 14
  • Patient Apps for Improved Healthcare IMS Institute for Healthcare Informatics Oct 2013 App categorization by functionality INFORM Provide information in a variety of formats (text, photo, video) INSTRUCT Provide instructions to user RECORD Capture user entered data DISPLAY Graphically display user entered data/output user entered data GUIDE Provide guidance based on user entered information; recommend consult REMIND/ ALERT Provide reminders to the user COMMUNICATE Provide communication with HCP/patients; provide links to social networks Tuesday, May 6, 14
  • Inform Instruct Record Display Guide Remind/alert Communicate Individual Functionality Multi-functionality Less than 1/2 of apps which provide information also provide instructions Approx 1/5 of apps which provide information also track/ capture user data Information Inform + Instruct Information Inform + Record Patient Apps for Improved Healthcare IMS Institute for Healthcare Informatics Oct 2013 Tuesday, May 6, 14
  • Patient Apps for Improved Healthcare IMS Institute for Healthcare Informatics Oct 2013 159 apps link to sensors 65 y vs 55% of those aged 45-54 y Tuesday, May 6, 14
  • Patients face a dizzying array of healthcare apps to choose from, with little guidance on quality or support from their doctors. Some efforts are underway to help provide professional healthcare guidance in both the US and the UK but these are limited in scope and impact to date. Tuesday, May 6, 14
  • Hyperwall by Florian Plag https://ic.kr/p/8aro3Y Its the Wild West out there. Its hard to sort through them all and theres little evidence about which ones really work. Murray Aitken Executive Director IMS Institute for Healthcare Informatics Tuesday, May 6, 14
  • What clinical tools do you currently use in practice? Do you want to replace the tool with an app? Does an app currently exist for the reference? Locate app via website link or through app store Begin search for substitution app Can the reference be replaced if not exact duplicate? Continue current practice Inquire for app: word-of-mouth or social media Search mobile app store Research apps through blogs or websites Search for published literature on apps Critically evaluate app Perform new search or maintain current practice Is the app useful for utilization in clinical practice? Incorporate app into daily practice YES YES YES YES NO NO NO Evaluate app based upon vital domains to ensure efcacy, safety, accuracy and continual support in use[ ] Fig 2 from Aungst TD et al Int J Clin Pract 2014;68:141-2. Screening apps for use in practice Tuesday, May 6, 14
  • Found a clue by Morgan https://ic.kr/p/6WMk48 Questions to ask before downloading an app Visser BJ & Bouman J. Student BMJ 2012;20:e2161 Clinical decision making Medical publisher Regularly updated Properly referenced Authors listed Feedback Recommended For health professionals ???Tuesday, May 6, 14
  • Found a clue by Morgan https://ic.kr/p/6WMk48 Questions to ask before downloading an app Visser BJ & Bouman J. Student BMJ 2012;20:e2161 Patients privacy Does the app require you to input patient specic data, and could this compromise patients privacy? ? Conicts of interest Do you know where the app is from? By a drug company or a non-commercial organization? Tuesday, May 6, 14
  • Mapping mHealth Research: A Decade of Evolution Fiordelli M, Diviani N, Schulz PJ. J Med Internet Res 2013;15(5):e95 Copyright Maddalena Fiordelli, Nicola Diviani, Peter J. Schulz. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.05.2013. Increase in the number of articles over the past decade (almost doubled from 20072008) Focus on chronic conditions 50% clinical trials; 44% pilot studies Small sample size (less than 50 people) Tuesday, May 6, 14
  • Currently, there are more than 15,000 health- related apps (free and paid) on app stores, but we were not able to nd any study assessing any of them. So what is publicly available has not been evaluated, and what has been evaluated is not publicly available. Mapping mHealth Research: A Decade of Evolution Fiordelli M, Diviani N, Schulz PJ. J Med Internet Res 2013;15(5):e95 Puzzle 1 by jakubson http://www.freeimages.com/photo/1072527 Tuesday, May 6, 14
  • Theres an app for that! Which app? Runkeeper a

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