Tools for Improving Adherence to Treatment in Diabetes Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM @endocrine_witch #HealthXPH Associate Professor, University of the Philippines College of Medicine Chief, University of the Philippines Medical Informatics Unit App Sketching by Johan Larsson, https://flic.kr/p/dHLKPt
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Tools For Improving Adherence to Treatment in Diabetes
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Tools for Improving Adherence to Treatment in Diabetes
Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM@endocrine_witch #HealthXPH
Associate Professor, University of the Philippines College of Medicine
Chief, University of the Philippines Medical Informatics Unit
App Sketching by Johan Larsson,https://flic.kr/p/dHLKPt
I, Iris Thiele Isip Tan DO NOT have a financial interest/arrangement or affiliation with any healthcare related companies that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
Adherence & mHealth
Black and White Crime 2 by Egahen,http://www.freeimages.com/photo/1115701
The App Store by PhotoAtelier,https://flic.kr/p/9rCQw8
Apps for diabetes
Runkeeper and health on iPhone by Jason Howie,https://flic.kr/p/e5CBwN
Eating salad for health by typexmick,http://www.freeimages.com/photo/1432591
“ AdherenceWHO definition (2003)
the extent to which a person’s behavior - taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider
Adherence to Long-term Therapies: Evidence for Action
mobile phone-conference image by xristine_faulknerhttps://flic.kr/p/4Xn9Q7
medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs) and other wireless devices
Features of Mobile Diabetes Apps: Review of the Literature & Analysis of Current Apps Compared Against Evidence-based GuidelinesChomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. J Med Internet Res 2011;13(3):e65
iPhoneAndroidBlackberryNokia
online markets + journal databases
+ gray literature on mobile apps
INCLUSION criterionself-monitoring
of blood glucose
EXCLUSION criteriaNo English user interface
Intended exclusively for HCPs
n = 973
n = 137 (101 online + 26 literature search) Smartphone icon by Loraw200,
Features of Mobile Diabetes Apps: Review of the Literature & Analysis of Current Apps Compared Against Evidence-based GuidelinesChomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. J Med Internet Res 2011;13(3):e65
SELF-MONITORING
Blood glucoseWeight
Insulin & medicationBP
EDUCATION
Disease-related
ALERTS & REMINDERS
Integration of SOCIAL
MEDIA functions
Disease-related DATA EXPORT &
COMMUNICATION
Synchronization with Personal Health Record (PHR) systems or patient portals
Features from brainstorming
of authors; focus group discussions between
MDs and patients
A tree on the horizon by Ydiot,http://www.freeimages.com/photo/1113494
GAP ANALYSIS [
Literature typically reflects emerging applications and new trends ...“... the market gives a good indication of mature applications and functionality.
Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. J Med Internet Res 2011;13(3):e65
A tree on the horizon by Ydiot,http://www.freeimages.com/photo/1113494
GAP ANALYSIS[
Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. J Med Internet Res 2011;13(3):e65
Features of Mobile Diabetes Apps: Review of the Literature & Analysis of Current Apps Compared Against Evidence-based GuidelinesChomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. J Med Internet Res 2011;13(3):e65
A CB
Variables in diabetes self-management NOT addressedPersonalized feedback
Patient monitoring by primary care physician
Foot & eye care
Psychosocial care
Immunization
Complication management
Very little influence of social media on current diabetes mobile applications
Provide link to groups on FB or TwitterNo functional links or integration
between information in app & social media
Instagram and other social media apps by Jason Howie,https://flic.kr/p/d41HES
Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. J Med Internet Res 2011;13(3):e65
Mobile Apps for Diabetics: A Systematic Review & Expert-based Usability Evaluation Considering the Special Requirements of Diabetes Patients Age 50 Years or OlderAmhold M, Quade M, Kirch W. J Med Internet Res 2014;16(4):e104
iOS n=276Androidn=266Both n=114
Smartphone icon by Loraw200,http://www.freeimages.com/photo/1377498
Apple by VanessaGF,http://www.freeimages.com/photo/1427461
An app a day keeps the doctor away. “ When a prescription drug goes
generic, it has at least seven years of data about its effectiveness and safety, which gives physicians assurance that patients can use it for self-care.
Medical apps have no history of either effectiveness or safety.
Mobile apps that are NOT medical devices ... will NOT be regulated by FDA.
Mobile apps may meet the definition of a medical device but because they pose a lower risk to the public, FDA intends to exercise enforcement discretion
Mobile apps may meet the definition of a medical device but because they pose a lower risk to the public, FDA intends to exercise enforcement discretion.
Caledos runner by Nicola,https://flic.kr/p/fP18Jx
Although the FDA has focused on safety, it has largely left the review and certification of apps to the marketplace.
The currently available reviews of mHealth apps have largely focused on personal impressions, rather than evidence-based, unbiased assessments of clinical performance and data security.
Powell AC, Landman AB, Bates DW. In Search of a Few Good AppsJAMA. Published online March 24, 2014,
Patient Apps for Improved HealthcareIMS Institute for Healthcare Informatics Oct 2013
Evaluation & Evolution of Diabetes Mobile Apps: Key Factors for HCPs Seeking to Guide Patients Ristau R, Yang J, White J. Diabetes Spectrum 2103; 26(4):211–215
PATIENT
DEMOGRAPHICSOlder generation less likely to be
technologically savvy
FINANCIAL BURDENCan the patient afford the device & the app?
Busy woman by JetMedia,http://www.freeimages.com/photo/1070268
Evaluation & Evolution of Diabetes Mobile Apps: Key Factors for HCPs Seeking to Guide Patients Ristau R, Yang J, White J. Diabetes Spectrum 2103; 26(4):211–215
DEVICE & APP
PLATFORMNot all apps available
for all platforms
APP FEATURESLogging & tracking, data sharing & social support,
SMS & reminders
EASE OF USE Easy to navigate,
modify, enter, retrieve & share data
GUIDELINES & REGULATIONSFollow guidelines?
FDA approved? Busy woman by JetMedia,http://www.freeimages.com/photo/1070268
Measurable behavior change is the desired outcome of diabetes education. The diabetes professional community must step into the market void and embrace mobile technology as part of the solution.