Fewer than half of the more than 1,000 healthcare related-apps reviewed by researchers appeared to be useful for their potential for patient engagement while also offering high quality and safety, according to an issue brief published by New York City-based The Commonwealth Fund.
The Commonwealth Fund is a private foundation that supports independent research on health care issues and makes grants to improve health care practice and policy. With Commonwealth Fund support, researchers Karandeep Singh, M.D. and David Bates, M.D and colleagues developed a framework for evaluating mobile health apps for their patient engagement potential, quality and safety.
Rising ownership of smartphones and tablets across social and demographic groups has made mobile applications, or apps, a potentially promising tool for engaging patients in their health care, particularly those with high health care needs, the issue brief authors stated. Healthcare providers increasingly view mobile health technologies as tools to engage patient populations in chronic disease management, and, the issue brief points out, growing evidence suggests that patient engagement is essential to successful care management programs targeting patients with high needs and high costs.
According to research from the Pew Research Center, nearly two-thirds of Americans now own smartphones, and ownership is rising among older adults (27 percent) and those with low household incomes (50 percent).
The issue brief was authored by several physicians and researchers, with Dr. Singh., assistant professor in the department of learning health sciences at the University of Michigan Medical School, and Dr. Bates, professor of medicine at Harvard Medical School and professor of health policy and management at the Harvard School of Public Health, identified as lead authors.
According to the issue brief, the researchers conducted a systematic search of iOS (Apple) and Android app stores and an analysis of apps targeting individuals with chronic illnesses to assess the degree to which apps are likely to be useful in patient engagement efforts.
“Usefulness was determined based on the following criteria: description of engagement, relevance to the targeted patient population, consumer ratings and reviews, and most recent app update,” Dr. Singh and Dr. Bates wrote.
The research team searched for apps using the following terms: alcohol, arthritis, asthma, bipolar, cancer, cirrhosis, cognitive impairment, chronic obstructive pulmonary disease, COPD, coronary artery disease, dementia, depression, diabetes, drug abuse, elderly, heart disease, heart failure, high blood pressure, hypertension, kidney disease, liver disease, lung disease, obesity, pain, smoking, and stroke, according to the issue brief.
Among the 1,046 health care–related, patient-facing applications identified by our search, 43 percent of iOS apps and 27 percent of Android apps appeared likely to be useful. The research team also developed criteria for evaluating the patient engagement, quality, and safety of mobile apps.
The researchers also constructed and used an engagement pyramid to determine how apps are meeting the needs of patients with differing levels of health care engagement. For instance, patients who are least activated in their own care may face health literacy or social barriers to care, which can be addressed through health education, reminders, and recording of health information. “Moderately activated patients who are informed and able to keep track of their health may benefit from being able to visualize and summarize their health information, receive guidance on next steps, and communicate with family members and health care providers,” Singh and Bates wrote.
“Finally, the most engaged patients may benefit from peer support delivered through social media or ongoing motivational challenges that can be delivered through “gamification”—that is, using elements of game design, like competition or point scoring, to make an activity more fun,” the authors stated.
The researchers then applied their evaluation framework to a sample of apps, including an app that anonymously connects users with trained “active listeners” for emotional support, counseling, and therapy to help address depression, anxiety, and stress and a medication management app that provides users with medication reminders, refill alerts, drug interaction warnings, and the ability to track medication side effects.
With the counseling and therapy services app, the researchers concluded that the app is designed to support highly engaged patients by connecting them to a private social network of active listeners. “While the app does not provide functions to support patients with low or moderate engagement levels, both a clinician and a non-clinician scored the app highly on recommendability. This app demonstrates that health apps need not provide a wide array of functionalities or target patients across the engagement spectrum to be useful,” Singh and Bates wrote.
With the medication management app, the researchers concluded that it is “an example of an app that appears to successfully meet the needs of patients with varying levels of engagement.”
In conclusion, the researchers noted that just as treatment needs to be tailored to the patient, the same applies to apps, as mobile health apps “appeal to different audiences by offering varied functionalities.”
“App quality and safety do not necessarily align with functionality and must be considered separately. In developing this framework, we discovered several apps that sacrificed quality or safety in the pursuit of added functionality,” Singh and Bates wrote. “Using a framework that considers the engagement, quality, and safety of mobile apps is critical for stakeholders to identify trustworthy apps that serve the needs of high-need, high-cost populations. While apps have tremendous potential to engage high-need, high-cost populations, a minority of patient-facing health applications on both the Apple and Android stores appear likely to be useful to patients.”
According to the issue brief, the research team is currently using its proposed framework to evaluate 143 apps targeting high-need, high-cost patients.
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