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Prescribing an app
 

Prescribing an app

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My presentation from Med 2.0

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    Prescribing an app Prescribing an app Presentation Transcript

    • 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-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 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 0.56 Office (MD) 0.21 Office (RN) 0.31 Little P, et al. BMJ. Aug 3 2002;325(7358):
    • 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?
    • 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
    • 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)
    • 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)
    • 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 strategy  Validated  Approved