Viewpoint: How to use health apps in practice

Dr Tom Micklewright explains how health apps can benefit people with long-term conditions and how GPs can establish which apps they could recommend or 'prescribe' to patients.

(Photo: Westend61/Getty Images)
(Photo: Westend61/Getty Images)

The pandemic has shown us the importance of embracing digital technology in practice but health tech goes way beyond online consult forms and prescription app services.

Patients are using their phones every day for banking, video and entertainment, so it is logical that GPs are increasingly encouraged to recommend apps to help patients as part of care pathways.

Yet with over 374,000 health and fitness apps in existence, finding the right app for the right patient can feel like finding the needle in a proverbial haystack.

Plus, the need for detailed medical reviews of health apps is becoming increasingly clear. Patients surfing through hundreds of apps on Google Play or the Apple App Store may identify options which look appropriate for their condition. However, there is little medical level scrutiny on these shop windows. Many apps are featured which have no clinical assurance, raise alarms about data privacy and are difficult to use. 

Having led on digital clinical governance, in my role as associate medical director at Push Doctor, and conducted independent reviews of many health apps myself, I know that whilst some apps are comprehensive, improving pathway efficiency and encouraging self-management by patients, others can fall down and could be harmful.

How to find trustworthy apps

There are options for NHS staff seeking trustworthy apps to recommend. Since 2017 staff have had access to an NHS App Library, although this is set to be closed, with apps featuring instead on pages of NHS.uk alongside specific conditions. 

Commercial app libraries are available both in the UK and globally and probably the best established in this country (with 60% of NHS regions using them) are libraries provided by ORCHA, the Organisation for the Review of Care and Health Apps. ORCHA offers affordable subscriptions and a rigorous review system.

On an ORCHA app library, apps with scores of over 65% are considered trustworthy, with many of the top apps scoring up to 90% and developers constantly addressing user feedback and making improvements.

If a patient asks about an app, a GP can review the app on their NHS or commercial app library before recommending it or suggesting alternatives. Whilst some apps are free to use, others require a one-off payment or subscription. GPs in some parts of the NHS are now able to purchase – effectively prescribe – apps through the NHS London Procurement Partnership Health and Social Care Apps Dynamic Purchasing System.

Is it worth prescribing an app? While many patients will throw away a prescription or fail to take the medication, there is growing evidence that a patient prescribed an app is more likely to use it. A study at the Mount Sinai hospital in New York noted a 92% engagement rate with patients when prescribing apps.

Recommended apps for GPs

Whilst some apps are simply educational, others provide comprehensive patient support and should be viewed as medical devices.

Those looking to manage heart health, for example, can use Fibricheck to monitor heart rhythm and heart rate by simply placing a finger on the screen of a mobile phone. Users prepared to pay for the premium service can share their results with a physician.

Intellin, an extremely comprehensive app, is the Fitbit of diabetes management apps, allowing users to track many variables including blood sugars, blood pressure, insulin levels, weight and height. It flags high risk areas for particular patients – problems with feet or eyes, for example, and offers tailored advice. The app offers a clinician’s dashboard, so a doctor can check, at a level far more advanced than any other system currently available, how a person manages their diabetes.

Mental health has been a key area of concern during the pandemic, particularly the mental health of teens and students. The Student Health App and, from the same developer, distrACT, both give sound advice, with articles written and referenced by doctors. DistrACT offers self-help strategies to those struggling with repeated patterns of self-harm.

MyAsthma offers a medication diary, a forecaster to help map out triggers and personalised action plans which give control to the patient.

GPEP Physio Exercise was designed with the help of NHS GPs and physiotherapists and can be used to offer self-help advice to patients.

Evidence is also beginning to emerge that prescribing apps for patients with long-term conditions can also help save the NHS money overall. Put simply, the more GPs prescribe apps and the more patients use them, the higher the return on investment in these technologies.

Whilst many practices have adopted digital health during the pandemic, embedding these new approaches when life returns to normal will benefit both patients and our overstretched health service. 

  • Dr Tom Micklewright is associate medical director at Push Doctor, GP in Cheshire West and Chester Area, and also a clinical advisor and app reviewer for ORCHA.

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