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In July 2023, a survey by the Organisation for the Review of Care and Health Apps (ORCHA) revealed that 68 per cent of people agree that digital health apps should be used within the NHS. Nearly half of everyone surveyed said they were already using a health app to self-manage their health.
Research by ORCHA in 2022 found that 83 per cent of people surveyed who had used a health app found it actively helped to improve their health and wellbeing. Some 55 per cent were using an app recommended by a healthcare professional, mainly GPs or pharmacists. In addition, people aged 18-44 said they would choose digital health to support a mental health condition over and above prescription medicines, such as an antidepressant.
“Great health apps are, right now, being prescribed by doctors to help their patients sleep better, manage their mental health, keep fitter, monitor medicine usage, and much more,” says Liz Ashall-Payne, founding CEO of ORCHA. “But all of us need better advice on how to choose a good-quality app. Consistently, more than half of the health apps we review fail to reach the standard required to be used by the NHS.”
Health apps and digital technology already play a significant role within healthcare. The NHS Long-Term Plan, published in 2019, expected that by 2029, people will be “helped to stay well, to recognise important symptoms early, and to manage their own health, guided by digital tools”. According to the Deloitte Centre for Health Solutions in October 2021, it is hoped that eventually health apps will become part of digitally enabled care pathways, broaden access to healthcare services, and improve the outcomes of current treatments.
App benefits
A National Institute for Health and Care Excellence (NICE) guideline on ‘Behaviour change: digital and mobile health interventions’ published in October 2020, stated that using mobile apps may help people change their behaviour, which may in turn help to improve their health: “Addressing health-related behaviours such as those relating to physical activity, smoking and alcohol intake can help reduce the risk of developing chronic conditions such as diabetes, cardiovascular diseases, respiratory conditions, cancer and liver disease. Digital and mobile interventions may also help people to self-manage, self-monitor or improve these behaviours and improve their mental, social and emotional wellbeing.”
Many people are using health tracking apps to improve their lifestyle and maintain healthier habits and there is a vast range of health tracking apps available. This includes calorie counting and weight management, fitness and exercise, periods and menstrual cycle, menopause symptoms, alcohol intake, sleep, mental health, and chronic conditions management. In August 2023, research at the University of British Columbia (published in JAMA Psychiatry) revealed that using exercise apps to track simple home workouts can help to reduce symptoms of depression and burnout.
“Health tracking apps offer immediate benefits by giving users insights into their daily habits like diet, exercise and sleep,” says Liz. “These insights allow for quick adjustments to improve health in the short term. Over time, consistent use of these apps leads to a deeper understanding of personal health patterns.”
Kantar research in October 2022 revealed that, overall, 39 per cent of people see improvements in their physical and emotional health when they monitor them with the support of technology. In addition, 78 per cent of health-conscious consumers believe that the social and community components embedded in fitness apps make it easier to practise healthy habits.
“That’s the equivalent of buying a random box of pills with no MHRA approval and swallowing a handful of them”
According to ORCHA research, people are 70 per cent more likely to use an app when a healthcare professional has recommended it and thus many health tracking apps could be used with the direct support of a healthcare professional – such as the community pharmacy team. Monitoring sleep patterns, for example, may help pharmacy teams suggest suitable self-help measures or over-the-counter (OTC) products.
“Self-tracking apps provide a self-monitoring aspect that can be an important component of sticking to a health programme,” says Kenny Chan, Numark lead information pharmacist. “With the help and guidance of pharmacists, these can be useful in empowering patients to take control of their own health. There is such a wide range of apps available that it should be easy to find one to suit their needs.”
Pharmacy focus
Liz says that pharmacy teams can educate customers on how to effectively use health tracking apps to monitor their health metrics and achieve their health goals. “Pharmacy teams can follow up with customers periodically to monitor their progress and provide ongoing support and encouragement,” she says. “This could involve reviewing updated health data from the tracking apps, adjusting recommendations as needed, and celebrating milestones achieved. Overall, by actively engaging with customers who use health tracking apps, pharmacy teams can play a valuable role in promoting health and wellness, guiding customers toward suitable, trusted and effective products.”
Pharmacy teams may be able to incorporate a health app into existing services, such as smoking cessation or weight management. “For people at risk of developing type 2 diabetes, heart disease or stroke, the use of health tracking apps can be particularly impactful,” says Liz. “By monitoring key metrics like blood sugar levels, cholesterol, blood pressure and weight, these apps empower users to make proactive lifestyle changes aimed at reducing their risk factors.”
“People are 70 per cent more likely to use an app when a healthcare professional has recommended it”
The NICE guideline in October 2020 warned that the effectiveness of health tracking apps can vary, however, and that they may not be suitable for everyone. For example, healthcare professionals should look out for people at risk of developing or resuming an eating disorder or other unhealthy behaviour (such as excessive exercise) while using a diet or exercise app. Some people who are trying to stop smoking may benefit more from direct, personalised text messaging rather than a general stop smoking health app. Health apps should also not be used to replace health advice from a healthcare professional.
“Health tracking apps can be useful when diagnosing and monitoring patient health,” says Kenny. “They have the capability to back up what, in the past, would have been an anecdotal description of symptoms. Pharmacists should remember that apps are only one tool and it’s still important to conduct thorough consultations when determining whether there’s an underlying health concern or lifestyle change needed. They can also be signposted as a tool for those looking for methods of taking control of their health and implementing advice given by pharmacists.”
Health tracking apps are increasingly being used in the self-management of chronic conditions to help patients make appropriate lifestyle changes and track their progress. Pharmacy teams could use this data to signpost patients via referral pathways to a GP or relevant healthcare professional, or provide relevant self care advice. An app can be used to monitor migraine symptoms and look for potential migraine triggers (in the same way as a symptoms diary). Healthcare apps may also help to monitor whether treatments or self-management approaches are working effectively. For example, Versus Arthritis charity has developed Arthritis Tracker, a free app for people aged 13-25, to help them rate their daily symptoms (pinpointing where the pain is on their body and how bad it is) along with energy levels, sleep, activity, emotions and medication side effects.
Menstruation tracking
Women often use an app or diary to keep track of their monthly periods. The apps may also log their premenstrual symptoms, mood changes and body temperature. Some women may use these apps to monitor their fertility or plan leisure activities and travel arrangements.
“Tracking periods can be useful for patients to understand their bodies better and can show when to expect cramps, why you may be craving a certain food, and help you understand mood fluctuations,” says Kenny Chan, Numark lead information pharmacist. “They can also help determine the length of an individual’s period cycle which, while averaging at 28 days, can range from 21-40 days. This is nothing to worry about if it’s the norm for their body, but any changes can indicate an issue and help pharmacists to refer to GPs when appropriate.”
Irregular periods may be sign of the perimenopause or polycystic ovary syndrome (PCOS). PCOS affects around one in 10 women in the UK and may cause irregular (or no) periods and difficulty getting pregnant. Some women also have excessive hair growth, weight gain, hair loss (or hair thinning) and oily skin or acne. There is no cure for PCOS, but treatments include lifestyle changes, e.g. weight loss and hormonal medicines such as the contraceptive pill. PCOS can cause infertility and pregnancy complications such as pre-eclampsia. Therefore, if women are experiencing irregular periods or struggling to conceive, it’s important that they are referred to their GP.
Choosing apps
According to ORCHA research in 2022, only 20 per cent of the 320,000 health apps available on the market at the time were safe to use. Many apps collect personal data and have the potential to use and share it as well. The ORCHA survey in July 2023 revealed that most people aren’t checking an app’s clinical credentials or privacy policy before they download it, instead relying on consumer reviews in the app stores.
“That’s the equivalent of buying a random box of pills with no MHRA (Medicines and Healthcare products Regulatory Agency MHRA) approval and swallowing a handful of them, hoping for the best,” says Dr Simon Leigh, ORCHA’s research director. “We’ve proven through academic studies that good consumer reviews are not a safe indicator of the quality of the app. In fact, as a rule, the higher starred the consumer reviews, the less compliant the apps are in terms of the required standards and accreditations. Consumers are putting far too much faith in anecdotal observations by others.”
ORCHA has launched a Digital Health Formularies product for healthcare professionals, to help them recommend complex apps and monitor their use by patients. The ORCHA Health App Libraries product contains health apps that are safe for patients to download and use without any medical help and is being used by various NHS trusts to create their own online Health and Wellbeing App Library.
ORCHA’s Think SAFE campaign helps to remind the public of the following guidelines before they download an app:
● SECURE – how secure is the app and does it have a clear privacy policy?
● ASK – have I asked a healthcare professional about this app choice?
● FIND – where did I find this app?
● EVIDENCE – does the app demonstrate clear evidence it was developed by someone with medical expertise.
“Using exercise apps to track simple home workouts can help to reduce symptoms of depression”
Translation apps
In Spring 2023, research published in the PM Healthcare Journal looked at the impact of language barriers in community pharmacies. The research revealed that community pharmacists often felt frustrated, anxious and helpless when communicating with patients who experience language barriers. The pharmacists believed that these language barriers reduced the quality and quantity of the information they provided. With only 14 per cent of community pharmacists reporting access to formal language barrier services, many were using non-validated alternatives, such as Google Translate, when speaking to customers.
In January 2024, another research study (published in the British Journal of General Practice) looked at ‘Providing care to marginalised communities: a qualitative study of community pharmacy teams’. In this research, some pharmacists highlighted that medication safety could be compromised if patients didn’t speak English as this could mean they didn’t understand why a medicine had been prescribed or how to take it safely and effectively. Communicating with patients with limited English was frequently mentioned as a barrier to providing care. Since pharmacy teams didn’t have access to translation services, they often relied on Google Translate via their smartphone.
In both studies, there were concerns over the accuracy of Google Translate and whether using the app could compromise patient safety. Better services and resources are therefore needed to improve communication between community pharmacy teams and non-English-speaking customers.
“Translation apps are a useful tool in overcoming language barriers in healthcare settings,” says Kenny Chan, Numark lead information pharmacist. “They should be viewed as a tool and not relied upon due to the practical shortcomings, i.e. accuracy in translations. That said, it’s rare that a translator would be available at the point of sale within a pharmacy, so these apps have a place in aiding initial conversations and creating rapport with new patients.”