Study: Medical apps improve Physician ability to answer clinical questions in resource limited areas

The disparity in access to quick and reliable information is often taken for granted in industrial nations. With a developed infrastructure and continuous support, our access to the internet and electronic communications has increased our access to clinical information. Contrast this with other nations, where the infrastructure is in development, and it is quick to see the disparity.

However, is there a way to overcome this through mobile technology and mobile applications?

Addressing this concern, Golbach et al. studied whether medical applications would be beneficial. Their study was conducted in a Botswana hospital, involving 18 medical residents. The residents were given smartphones (myTouch 3G Slide HTC Android) loaded with Medscape, Unbound Medicine, Skyscape, Epocrates, and PubMed4Hh (PubMed for Handhelds). Clinical questions were given to the residents, who were then asked to answer with the clinical apps versus PubMed4Hh.

Questions were broken down into six areas: drug-related, diagnosis/definitions, treatment/management, pathophysiology, epidemiology, and prevention.

Results demonstrated a statistical difference in the answers provided by the medical apps versus PubMed4Hh. The medical apps demonstrated a higher correct response for drug-related (63% vs 13%), diagnosis/definitions (33% vs 12%), and treatment/management (41% vs 13%), while PubMed4Hh was better suited for epidemiologic questions. Overall, medical related apps provided correct answers 36.22% of the time, while PubMed4Hh was only correct 14.08%.

Limitations noted by the authors included the nature of diseases being encountered by the residents. In most cases, the answers were available, unless they dealt with what would be called in the US “exotic cases” such as African tick bite fever. PubMed4Hh was better suited for searches also, as it was easier to search via PubMed for abstracts dealing with these types of diseases and inputting search terms that may find some form of answer (e.g. “albuterol for bronchiolitis). This is due in part to the fact that most apps do not currently have a robust search system, and instead rely on searching for only a singular term to find an answer (e.g. bronchilitis).

This study gives some thought for any future study designs as well as shortcomings of  future app designs. First, future studies should elucidate which apps are beneficial for what situation. For example, are drug-referencing apps better than a clinical suite for drug toxicities or dosing? Next, while the authors defended the use of using PubMed4Hh, I am unsure if this was a fair comparison. This is because the apps utilized covered a large area of clinical information that PubMed alone does not. In some sense, this study seems biased towards the apps to begin with.

Nevertheless, future studies should look into whether using apps in such areas is beneficial in terms of cost and speed to clinical decision making, which may be a great way to engage such communities. Perhaps future outreaches or mission trips should look into sharing or studying the impact of using mobile devices and their associated apps versus standard tools onsite. Lastly, developers can look at this study and address the shortage of apps designated for epidemiological questions. They can also start developing better search engines in their apps to help users elucidate answers similar to PubMed or other such databases.

Reference:
Goldbach H, Chang AY, Kyer A, et al. Evaluation of generic medical information accessed via mobile phones at the point of care in resource-limited settings. J Am Med Inform Assoc. 2013; In Press.