0
Take two apps and call me in
the morning
Prescribing 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-rela...
Blood pressure control is more
important blood sugar control
525,600minutes in a year
minutes are
assessed with
office BP
Gold standard for blood pressure
assessment is 24-hour
ambulatory blood pressure
monitoring
Patient assessed home blood
pr...
Home blood pressure
readings are better than office
readings at predicting end-
organ damage (left ventricular
hypertrophy...
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
• Tim...
Can we go further?
 Patients titrate insulin based on blood
sugar
 Can patients titrate antihypertensive
medications bas...
152.1
139
134.9
151.8
142.4
140.1
125
130
135
140
145
150
155
Baseline 6 Months 12 Months
Systolic Blood Pressure
Interven...
The intervention group
 more medications prescribed
(p=0.001)
◦ 0.3 at 6 months
◦ 0.4 at 12 months
 fewer clinic visits ...
PatientswithEvents(%)
0
5
10
15
20
Years Post-Randomization
0 1 2 3 4 5 6 7 8
Primary Outcome
Nonfatal MI, Nonfatal Stroke...
We pay for tight blood
pressure control with acute
renal failure, hypotension and
What I want in a prescription app
 Public algorithm
 Partners with the physician to choose
the appropriate titration str...
Prescribing an app
Prescribing an app
Prescribing an app
Prescribing an app
Prescribing an app
Prescribing an app
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Prescribing an app

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Transcript of "Prescribing an app"

  1. 1. Take two apps and call me in the morning Prescribing code instead of pills, clinician perspective
  2. 2.  Joel M Topf, MD  @Kidney_boy  @eajkd  www.Pbfluids.com
  3. 3. Kidometer
  4. 4. KDIGO iPad app
  5. 5. 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
  6. 6. Blood pressure control is more important blood sugar control
  7. 7. 525,600minutes in a year minutes are assessed with office BP
  8. 8. 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 0.56 Office (MD) 0.21 Office (RN) 0.31 Little P, et al. BMJ. Aug 3 2002;325(7358):
  9. 9. Home blood pressure readings are better than office readings at predicting end- organ damage (left ventricular hypertrophy, atherosclerosis), cardiovascular events and total mortality
  10. 10. but this amazing technology is useless if you forget your numbers… …no patient ever forgets her phone
  11. 11. 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
  12. 12. Can we go further?  Patients titrate insulin based on blood sugar  Can patients titrate antihypertensive medications based on blood pressure?
  13. 13. 152.1 139 134.9 151.8 142.4 140.1 125 130 135 140 145 150 155 Baseline 6 Months 12 Months Systolic Blood Pressure Intervention Control 85 79.6 77.4 84.5 80.3 79.5 72 74 76 78 80 82 84 86 Baseline 6 Months 12 Months Diastolic Blood Pressure
  14. 14. 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)
  15. 15. PatientswithEvents(%) 0 5 10 15 20 Years Post-Randomization 0 1 2 3 4 5 6 7 8 Primary Outcome Nonfatal MI, Nonfatal Stroke or CVD Death HR = 0.88 95% CI (0.73-1.06)
  16. 16. We pay for tight blood pressure control with acute renal failure, hypotension and
  17. 17. What I want in a prescription app  Public algorithm  Partners with the physician to choose the appropriate titration strategy  Validated  Approved
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