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

description

Presentation at the 2014 Asia-Pacific Endocrine Conference: Optimal Management of Diabetes & Thyroid Diseases. 7 June 2014 at New World Hotel, Manila.

Transcript of Tools For Improving Adherence to Treatment in Diabetes

Page 1: Tools For Improving Adherence to Treatment in Diabetes

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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Disclosure Statement of Financial Interest

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.

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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

Apps (un)regulated

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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

Apps (un)regulated

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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

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In developed countries, adherence to long-term therapies in the general population is around 50% and is much lower in developing countries.

WHO report (2003)“

Take your medicine! by Morgan,https://flic.kr/p/6jfAxH

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The Five Dimensions of AdherenceWHO (2003)

Adherence to Long-term Therapies: Evidence for Action

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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

“ mHealthWHO definition (2011)

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mHealth research

2002-2012

Mobile phone in hand 2 by DragonTash,http://www.freeimages.com/photo/1438235

Health promotion (38%)

Self-management (33%)

Communication (22%)

Remote monitoring (21%)

Data gathering (21%)

Improvement of adherence (20%)

Training/education (17%)

mHealth Research Impact AreasFiordelli M et al. Mapping mHealth research: a decade of evolution

J Med Internet Res 2013;15(5):e95

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Conditions addressed by mHealth researchFiordelli M et al. Mapping mHealth research: a decade of evolution

J Med Internet Res 2013;15(5):e95

DiabetesObesity/Overweight

Mental health Tobacco use

Other kind of chronic condition HIV

Other acute conditionsWell-being

CancerMedication compliance/Appointment reminder

Sexual health Cardiovascular condition

Tuberculosis 0 5 10 15 20 25

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MeasurementOn-person or embedded sensor sampling in real time

Ecological Momentary Assessment

Global positioning system

DiagnosticPoint-of-care diagnostics

Portable imaging

Biomarker sensing

Clinical decision supportSensor sampling for diagnostics

Treatment/PreventionPrevention & wellness interventions

Remote behavioral treatment

Medication adherence trackingChronic disease management

Dissemination of health information

Disaster support/care

GlobalAccess to healthcare services

Remote behavioral treatment

Dissemination of health information

Disease surveillance

Medication tracking and safety

Prevention & wellness interventions

Continuum of mHealth ToolsKumar S. et al. Mobile Health Technology Evaluation: The mHealth Evidence Workshop. Am J Prev Med 2013;45(2):228–236

Arrow background by ralev_com,http://www.freeimages.com/photo/1169793

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conectandonos by El_Turista_Accidental,https://flic.kr/p/7EWqg3

There’s an app for that!

Patient Apps for Improved Healthcare: From Novelty to Mainstream (Oct 2013)

IMS Institute for Healthcare Informatics

40,000+ healthcare apps on US Apple iTunes app store

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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

Apps (un)regulated

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Patient Apps for Improved HealthcareIMS Institute for Healthcare Informatics Oct 2013

n= 43,689 apps

Healthcare & Fitness or Medical

n= 20,007 apps

Miscategorized or only loosely health related

n= 23,682 apps

Genuine healthcare related

n= 16,275 apps

Consumer oriented

n= 7,407 apps

Healthcare professional oriented

1,980 therapy area specific apps

270 apps for endocrine, nutritional & metabolic diseases

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Patient Apps for Improved HealthcareIMS Institute for Healthcare Informatics Oct 2013

Functionality score + User score = IMS Health App Score

No. of reviews + star rating [ ]

25 individual criteriainformation provided how user data tracked/capturedcommunication processesquantity of device capabilities[ ]

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Top diabetes appsstrong functionality with ease of use

IMS Health App ScoreIMS Institute for Healthcare Informatics Oct 2013

Daily CarbMaxwell Software

Glucose BuddyAzumio, Inc.

GoMealsSanofi Diabetes

1

2

3

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Currently, there are more than 15,000 health-related apps (free and paid) on app stores, but we were not able to find 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

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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,

http://www.freeimages.com/photo/1377498

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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

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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

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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

Literature Search

PHR or Web server

synchronization18 (69%)

Insulin & medication

recording 17 (65%)

Diet recording 17 (65%)

Data export &

communication 16 (62%)

Insulin & medication

recording 63 (62%)

Data export &

communication 61 (60%)

Diet recording 47 (47%)

Weight management

43 (43%)Online Market

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#1 Insulin/meds#2 Communication#3 Diet#4 Physical Activity

#5 Weight#6 BP#7 PHR

#8 Education#9 Social Media#10 Alerts

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

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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

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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

GENERAL INFORMATIONName/languageDate of release/

updateDesktop app

OPERATING SYSTEM

iOSAndroid

Both

DEVELOPER INFORMATION

Name

POPULARITY/USER RATINGSNo. of downloads/

installationsUser rating

No. of user ratings

TARGET USER

GROUPSPatients

Physicians/qualified health personnel

Both INTERFACESInterface/

connectivity to external sensor(s)/

device

ACQUISITION COSTS Freeware

Exact priceAvailability

as”lite” version

Feb-Apr 2013

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0

25

50

75

100

Free Paid Paid/Lite

iOS (n=276) Android (n=266)Both (n=114) Total (n=656)

Price distribution of diabetes apps and “lite” versionsAmhold M, Quade M, Kirch W. J Med Internet Res 2014;16(4):e104

%

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Worried senior woman talking by SalFalko,https://flic.kr/p/gFCeMN

Usability & Assessment Criteria for Diabetes Apps for ElderlyAmhold M, Quade M, Kirch W. J Med Internet Res 2014;16(4):e104

COMPREHENSIBILITYUse of understandable semantics, simple comprehensibility & interpretability of displayed

images and depictions, simple self-explanatory menu structures

USABILITYInstant and easily understandable feedback, intuitive usability,

simple recognition of click-sensitive areas

PRESENTATION (Image & Text)Sufficient color contrast, large size of operating elements, ability to adapt the size of

operating elements and displayed images

GENERAL CHARACTERISTICSHigh fault tolerance/efficient fault management,

password-protected services

Randomly selected 66/656 apps (iOs n=29, Android n=28, Both n=9)

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Comprehensibility

Presentation

Usability

General characteristics

0 1 2 3 4 5Likert Scale

Usability Assessment of Diabetes Apps for ElderlyAmhold M, Quade M, Kirch W. J Med Internet Res 2014;16(4):e104

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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

Apps (un)regulated

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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.

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Hyperwall by Florian Plaghttps://flic.kr/p/8aro3Y

It’s the Wild West out there. It’s hard to sort through them all and there’s little evidence about which ones really work.

Murray AitkenExecutive Director

IMS Institute for Healthcare Informatics

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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.

Mike PaskavitzEditor-In-Chief, Quantia Inc

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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.

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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,

doi:10.001/jama.2014.2564

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http://spectrum.ieee.org/biomedical/devices/bluestar-the-first-prescriptiononly-app

This is a piece of software getting the same treatment as a medical device. It’s pretty world-changing.

Sonny VuCofounder, Misfit Wearables

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Patient Apps for Improved HealthcareIMS Institute for Healthcare Informatics Oct 2013

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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

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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

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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

Apps (un)regulated

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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.