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Patients, nephrologists, consumer ratings disagree on CKD app efficacy
Following a study of 28 kidney disease maintenance apps for smartphones, researchers found only a small subset of these apps was highly rated by both patients and nephrologists. Additionally, patient impression of mobile app quality was not correlated with consumer app ratings or nephrologist impression, according to the study.
Components of self-care for patients with CKD include medication, dietary adherence, self-monitoring blood pressure and physical activity. Researchers hypothesized that smartphone apps developed specifically for CKD management could improve self-care monitoring in patients.
“Patient education and self-monitoring have historically relied upon face-to-face visits with physicians, handouts and written diaries,” the authors wrote. “There is growing evidence that incorporating technology, specifically smartphone-based applications (apps), can help support self-management in CKD and chronic disease more generally. Randomized, controlled trials support the use of mobile health apps in the self-management of diabetes and obesity, yet few studies have formally evaluated apps in the context of kidney disease.”
Researchers identified 339 potential Android and iOS apps and, after excluding those not related to CKD, not patient-facing or updated no later than 2014, 12 Android apps; 11 iOS apps; and five dual-platform apps remained. Two patients and three nephrologists performed the evaluations of each app and patient engagement, as well as quality of the apps was assessed by both groups. Usability of the apps was assessed by patients only, and safety was assessed by the nephrologists.
Using the patient and nephrologist evaluations, researchers examined pairwise correlations for the patient, nephrologist and consumer ratings of each app. Using this method, investigators found quality ratings by patients and nephrologists, assessed by a net promoter score, were not correlated. Additionally, patient ratings of app quality did not corollate with the consumer ratings in the app store.
“[Prior] research has shown physician and consumer ratings of apps to be poorly correlated, this is the first study to demonstrate that patient ratings of apps correlate poorly with both physician ratings and consumer ratings,” the authors wrote. “This is not surprising because focus groups show that CKD patients and nephrologists often disagree on which aspects of their care are most important. Disagreement on the quality of the apps may similarly reflect competing priorities for patients and providers. This has important implications because national efforts to evaluate apps — led in part by the American Medical Association — have focused on the content quality and security rather than on patient perceptions of usefulness.”
Nephrology News & Issues corresponded with study co-author, Karandeep Singh, MD, MMSc, assistant professor of learning health sciences, internal medicine and information at the University of Michigan.
“This study is a first step toward understanding the marketplace of patient-facing apps on the app store to support patients’ self-management of chronic kidney disease. We found that patients’ and physicians’ evaluations of app quality were not correlated,” Singh said. “We found a number of apps that were rated highly by patients but not by nephrologists, suggesting that the two groups may have different priorities when they decide which apps are useful. If nephrology professional groups are going to recommend apps for patients to use for specific aspects of their care, they should strongly consider seeking patient input because patients have a unique perspective about app quality.”
Singh added that one of the limitations of the study was that they’d studies a small sample size of apps, considering their fast turnover rate in the app stores. Many of the apps that were analyzed are no longer available for download. Additionally, Singh noted that patients tend to use a wide variety of apps, not just ones specifically targeted toward individuals with CKD, for self-management.
“We were surprised to note that patient ratings of app quality did not correlate with star ratings on the app store, although this finding may be limited due the small number of apps that we evaluated along with the fact that many of the apps we identified had no app store ratings,” Singh said. “We were also surprised to find that the majority of apps were developed by individuals as opposed to organizations, such as medical professional groups or patient advocacy groups.” – by Scott Buzby
Disclosures: Singh is an assistant professor of learning health sciences, internal medicine and information at the University of Michigan and claims no relevant financial disclosures. The other co-authors report no relevant financial disclosures.