prescribing an app
DESCRIPTION
My presentation from Med 2.0TRANSCRIPT
Take two apps and call me in the morningPrescribing code instead of pills, clinician perspective
Joel M Topf, MD
@Kidney_boy
@eajkd
www.Pbfluids.com
Kidometer
KDIGO iPad app
UK Prospective Diabetes Study
An intensive glucose control policy HbA1c 7.0 % vs 7.9 %
reduces risk of
◦ any diabetes-related endpoints 12% p=0.030
◦ microvascular endpoints 25% p=0.010
◦ myocardial infarction 16% p=0.052
A tight blood pressure control policy 144/82 vs 154/87
mmHg reduces risk of
◦ any diabetes-related endpoint 24% p=0.005
◦ microvascular endpoint 37% p=0.009
◦ stroke 44% p=0.013
The benefit from tight glycemic control is less
than the benefit from lousy blood pressure control
Blood pressure control is more important blood sugar control
525,600minutes in a year
4 minutes are assessed with office BP
Gold standard for blood pressure assessment is 24-hour ambulatory blood pressure monitoring
Patient assessed home blood pressures are more than twice as correlated than physician measured office blood pressures.
Home 0.56Office (MD) 0.21Office (RN) 0.31
Little P, et al. BMJ. Aug 3 2002;325(7358):254.
Home blood pressure readings are better than office readings at predicting end-organ damage (left ventricular hypertrophy, atherosclerosis), cardiovascular events and total mortality
but this amazing technology is useless if you forget your numbers…
…no patient ever forgets her phone
Easiest blood pressure diary is the camera phone
• No app to download• You already know how to use it • No cheating• Time and date stamped
Can we go further?Patients titrate insulin based on
blood sugar
Can patients titrate antihypertensive medications based on blood pressure?
Baseline 6 Months 12 Months
125
130
135
140
145
150
155 152.1
139
134.9
151.8
142.4140.1
Systolic Blood Pressure
Intervention Control
Baseline 6 Months 12 Months72
74
76
78
80
82
84
86 85
79.6
77.4
84.5
80.379.5
Diastolic Blood Pressure
The intervention group more medications prescribed
(p=0.001)
◦0.3 at 6 months
◦0.4 at 12 months
fewer clinic visits (NS)
◦3.2 visits versus 3.5 for the control group
improved quality of life (NS)
Pat
ien
ts w
ith
Eve
nts
(%
)
0
5
10
15
20
Years Post-Randomization0 1 2 3 4 5 6 7 8
Primary Outcome Nonfatal MI, Nonfatal Stroke or CVD Death
HR = 0.8895% CI (0.73-1.06)
We pay for tight blood pressure control with acute renal failure, hypotension and low potassium
What I want in a prescription app
Public algorithm
Partners with the physician to choose the appropriate titration strategy
Validated
Approved