Assessment and potential use of health apps
Of the respondents, 36% expressed a generally positive opinion towards health apps compared to 43% more sceptical respondents; 21% expressed no particular preference. Physicians in medium-sized and large towns and cities saw health apps in a considerably more favourable light than their counterparts in small towns and rural communities (44% vs. 27%, p < 0.001). Respondents below the average age saw these apps far more favourably than did their older colleagues (46% vs. 23%, p < 0.001). Assuming correct application, 39% thought that health apps would make a large or very large contribution to health promotion, whereas 50% expected this contribution to be rather low; 5% did not expect any contribution, and 6% did not respond.
The perceived benefits of apps varied by application area. Of the physicians asked, 90% considered the use of mHealth tools as beneficial in managing medicines and medical appointments such as vaccinations and preventive screening. In addition, 88% welcomed support from patient self-management in risk factors such as bodyweight, blood pressure, blood sugar and similar, and weight data such as steps taken, and fluid volumes ingested. A further 76% saw benefit in using apps with physical activities such as exercises followed by features helping patients maintain a healthy lifestyle such as diet management and smoking cessation (65%). Finally, 59% advocated app support in monitoring and treating chronic diseases.
Respondents associated health apps with both opportunities and threats (Table
1, total approval). Perceived benefits included patient motivation and compliance. However, many of the physicians feared increased workload with frequent app usage as patients perceived general practitioners as their contact person. Some of the doctors pointed to data privacy issues and fears of unwanted effects such incorrect measurements.
Table 1
Perceived opportunities and threats in health apps. Question: Which of the following statements do you agree with? (N = 2138)
Health apps raise motivation and willingness amongst patients to do something for their health | 60 |
Health apps mean more rather than less work for physicians due to the additional responsibilities they cause | 55 |
Health apps are too complicated for many patients to use, which could result in false health data being collected and treatment failure in extreme cases | 49 |
Health apps are often untrustworthy as they do not adequately ensure data privacy | 44 |
Health apps improve patient compliance | 41 |
Health apps detract from the personal element in doctor–patient relationships | 40 |
Health apps generate a wash of data that hinder fast and effective patient treatment | 36 |
Health apps provide support in briefing patients on health and disease issues | 35 |
Health apps are too time-consuming for physicians and patients to use | 31 |
Health apps encourage patients to self-diagnose and self-treat without seeking professional medical advice | 27 |
Additional information covered by health apps help physicians treat patients more effectively and personally | 25 |
Health apps make planning doctor’s appointments more effective | 23 |
Health apps make consultation between physician and patient easier | 21 |
Using health apps speeds up the process of identifying and diagnosing diseases and disease risks | 21 |
Health apps relieve doctors and nurses as they no longer have to worry about the recording health data and measurements | 15 |
App use in patient care and physicians’ own experiences
Of the respondents, 61% estimated that up to 10% of their own patients used at least one app occasionally or frequently, 24% speculated on a usage frequency of 10–20%, and 8% assumed more than 20%.
Around one in four (24%) responded that they had many or at least some patients that had sent or brought their health data in printed or digital form—blood pressure or blood sugar diaries, asthma diary, stroke risk test and similar—to the doctor’s office (a few patients according to 54% and none according to 22%). A total of 29% of doctors in large cities responded that they had many or a moderate number of such patients compared to 15% of physicians in rural communities (p < 0.001).
One in four general practitioners (25%) indicated that they had frequently or occasionally had their own patients mention healthcare apps; 37% said that this had been rare, and 35% never. Physicians frequently or occasionally asked about health apps were above average in number in medium-sized to large urban areas and less frequent in small towns and rural communities (32% vs. 17%, p < 0.001).
Of all respondents, 18% had frequently or occasionally recommend specific apps to patients for prevention, lifestyle changes and/or treatment, whereas 26% had seldom recommended apps and 56% had never recommended them. These recommendations were given more frequently in urban doctor’s offices compared to rural settings (23% vs. 12%, p < 0.001). According to a response to an open-ended enquiry, the app recommendations most commonly given focused on electronic blood pressure or blood glucose journal apps and preventive apps encouraging exercise and fitness, weight loss and diet control. Lifestyle-supporting applications for diabetics and apps for stress management and increased resilience were also frequently recommended.
Physicians that recommended apps (n = 943) named a variety of criteria to be met before a health app could be considered for recommendation. These criteria mainly consisted of guarantees for data privacy (84%), ease of use, simplicity and usability (75%), personalisation options (55%) and a recognisable feature that would motivate patients towards health awareness and self-care in everyday life (such as gamification features as named by 52%). Some physicians (44%) placed importance on documented app benefits (e.g., certificates, studies, and reviews), and some (39%) saw compatibility with conventional doctor’s office software as important in allowing portability for health data.
Only a small number (23%) saw themselves as capable of distinguishing good from poor quality in apps, or claimed to have a good general overview of the apps available (15%). Only 22% saw themselves as capable of counselling patients on health apps. Developing on the above, physicians in urban environments saw themselves as capable more frequently than did physicians in small towns and rural communities (28% vs. 16%, p < 0.001). Urban general practitioners also researched health apps more frequently (50% vs. 34%, p < 0.001).
Later on in the survey, the respondents were asked to think about those amongst their patients that used health apps regardless of whether they were acting on doctor’s advice or not. Asked about their experience, 54% responded that health apps had generally shown a very favourable or favourable influence on preventive healthcare and/or recovery amongst their patients. Few at 15% saw a negative impact on patient wellbeing, while 14% did not know any patients that were using them; 17% did not respond to this question.
The question as to the legitimacy of general practitioners relying on data collected by patients using apps in treatment planning was met with controversy amongst the respondents. In all, 37% saw it is reasonable to include the data, but the majority at 57% were against it and 6% did not provide an answer. Finally, 44% of all the physicians up to the age of 54 agreed with the inclusion of app data in treatment planning compared to only 24% of the older physicians (p < 0.001).
Doctors with patients that had sent or brought health app data in printed or digital form to the doctor’s office (n = 1670) were asked whether they themselves had also used health app data in treatment planning: 54% stated they did, whereas 22% said they would never include app data.
Approaches towards optimising the use of apps at doctor’s offices
The results from the preliminary study and literature research were used as a basis for various proposals towards optimising the use of apps in primary care for comparison (Table
2). Most of the respondents wanted to see authoritative data privacy and quality standards defined in order to make health apps more attractive in patient care. Some also expressed a desire for mandatory certification in new apps. Respondents saw importance in clarifying the legal issues involved in using apps in patient care as an urgent measure towards improving the general conditions for using these apps. Further system training programmes for physicians was also seen as important.
Table 2
Approaches to optimising health app integration
Question: Out of the following suggestions on improving the quality of health apps, which do you think are especially important? (N = 2138) | Overall approval (%) |
Definition of authoritative data privacy standards for health apps to ensure the protection of consumers and patients | 66 |
Legal definition of quality criteria that must be met by health apps to ensure their trustworthiness | 54 |
Obligation of providers to have their new health apps certified before they reach the market | 37 |
Audit by regulatory authority on each app before market launch | 35 |
Question: Out of the following suggestions on improving general conditions for the use of health apps, which do you think are especially important? (N = 1070) | Overall approval (%) |
The fee schedule should regulate payment for medical services in connection with apps (consultation service code for assessing and evaluating data documented electronically by the patient) | 73 |
Physicians should not have to risk liability such as in medical malpractice suits arising from a faulty health app | 68 |
Health app system training programmes for physicians, especially in primary care, with sufficient CME-certified training | 54 |
Doctors should be able to select from a wide range of health or medical apps on prescription in treatment planning for patients | 20 |
Insurance policy holders from all public health insurance organisations should receive bonuses or bonus programmes for using certain apps regularly and transferring the data to the health insurance | 11 |
Following that, the physicians were asked whether they would be generally more likely to consider including health apps in patient care if the points they specified (Table
2) were implemented. 19% responded “Yes, far more likely” and 53% “Yes, somewhat more likely,” while 19% were against it, and 9% did not respond.
Referring to the possibility created by the federal government to prescribe health apps under certain circumstances, 47% of the respondents said they could imagine using this in the future; 24% said no; 26% were undecided; and 3% did not respond. Respondents saw potential application areas for the use of apps in prevention medicine such as exercise training and gymnastics, physical therapy and rehabilitation, and dietary control. Many also responded that the apps could also be used in diabetes as well as headache and backache.