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AD apps for patients not meeting international standards

One-third of mobile device apps intended to aid patients in managing atopic dermatitis (AD) provide information inconsistent with international guidelines on management and treatment of the condition, researchers report online ahead of print in British Journal of Dermatology (June 9, 2019).

Of 98 assessed apps, none fulfilled the complete set of criteria for educational information, tracking functions or health information principles, as set out by international AD management recommendations such as the Guidelines for the Management of Atopic Dermatitis in Singapore and the UK’s National Institute for Health and Care Excellence guidelines.

In a press release, the study’s senior author Associate Professor Josip Car, who chairs the Health Services and Outcomes Research Programme at Nanyang Technological University’s LKCMedicine in Singapore, said the field of mobile health has great potential to lead to better patient care and self-management of AD, provided that appropriate measures are taken to improve the quality standards of AD management apps.

“Smartphone apps have emerged as a novel approach to support the self-management of conditions that require long-term care, such as eczema,” said Dr. Car. “Our research shows that there is a large variance in the quality of eczema apps. While the assessed eczema self-management apps had shortcomings, certain apps did provide appropriate functions with accurate information and comprehensive tracking of eczema-related factors.”

The study comprised a systematic assessment of AD apps—67 in English, 22 in Chinese, and 9 in Spanish—conducted from July to Nov. 2018, with assessment criteria based on conformance with international eczema guidelines. Investigators assessed consistency and comprehensiveness of eczema specific educational information; quality and comprehensiveness of eczema specific tracking functions; and compliance with health information best practice principles.

In the press release, Matthew Gass from the British Association of Dermatologists was quoted saying: “It is important that researchers continue to test the accuracy and safety of health apps. There has been an enormous boom in the number of dermatology apps available to the public, and with this comes the risk that some will be inaccurate, and even unsafe. Similar concerns have been raised in the past regarding skin cancer apps.

“App developers should clearly label the sources of their information and should make use of existing resources such as published National Institute for Health and Care Excellence guidelines in the UK,” said Gass. “There is no doubt that apps will play a big role in the self-management of skin conditions, but we should have high standards for any health apps.”

Of the apps assessed, 84% provided educational information, 39% tracking functions, and 13% both. Among 38 apps with a tracking function, 82% measured specific symptoms, disease severity or current skin condition and 89% helped users to record medication usage including application of topical treatments. Of the apps, 34% recorded environmental or dietary allergens.

In addition to the 34% of apps providing information that was not in agreement with international guidelines, only 15% provided information supported by international guidelines on pharmacological therapies and 16% on non-pharmacological therapies. None of the apps included in the study complied with all criteria for educational information, tracking functions or health information principles. As well, 11% of the apps failed to mention mainstay therapies such as the use of emollients and moisturizers.

Dr. Car, who is also Director of the Centre for Population Health Sciences at NTU, said, “Perhaps the most useful way to address this issue would be to publish a list of recommended apps to aid clinicians in suggesting the appropriate options for eczema patients and caregivers.”

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