By Sheryl Ubelacker
TORONTO ? When Sara Nita?s son Marcus was diagnosed with Type 1 diabetes last fall, she began keeping a written log of his multiple daily blood-sugar readings.
But she soon started casting around for a way to keep an electronic record, something she could enter into her smartphone that would not look like a bunch of numbers, but show trends in Marcus?s glucose levels over time.
What she discovered was the Bant app, a free download through iTunes named after Canadian insulin developer Frederick Banting, that?s aimed at helping patients better control their diabetes.
?I wanted something that I could view on my phone when he?s away at school and the teacher calls and says: ?Do you remember what he was, whenever?? So I just wanted to have a log of it, instead of carrying a paper copy here and there and everywhere.?
Nita says the app also allows her to send screenshots of Marcus?s readings to his dad, from whom she is divorced, so he can also stay on top of the six-year-old boy?s blood sugar. Graphs of readings show trends over time.
?I really like it because it shows ups and downs, and the way you can tell if he?s starting to decline, maybe he might need a little less insulin or a little more, depending on his history in the last couple of days.?
It also helps her son, she says. ?When he realizes his trends, he can say ? maybe I should talk to Mom about maybe changing my insulin dose, maybe calling the doctor to get an adjustment.??
The Bant is just one medical-related app under development by the University Health Network in Toronto.
Nita is using the public version of Bant, but UHN hopes to have a more advanced adaptation that automatically reads the data from a glucometer ? the device that takes blood-sugar readings from a skin prick ? available for free download soon.
?This is something to engage the patient in what we call self-care,? says co-developer Joseph Cafazzo, a biomedical engineer who heads the Centre for Global eHealth Innovation at UHN. ?And to a certain extent make them less dependent on their care providers and give them the life skills that they need in order to manage their diabetes.?
Cafazzo?s team has also developed an app to keep track of blood pressure readings in patients aged 45 and older. In a recent clinical trial, use of the app was shown to have measurable effects on patients? blood pressure compared to a control group that used a blood pressure monitor alone.
?What we found after a year was the people who had the telemonitoring component with the BlackBerry, their blood pressure dropped by 10 millimetres of mercury systolic and four points diastolic,? he says ?And what that means is that their risk of heart attack and stroke dropped by 20 per cent as a result.
?So this was truly self-care?. The patients just become much more self-aware by taking the blood pressure measurements on a regular basis. And they?re more engaged and they?re more likely to take their medications and more likely to have lifestyle changes that are necessary for their blood pressure management.?
There has been an explosion of medical-related apps ? a recent report by the Healthcare Information Management System Society tabbed the number at about 17,000 and growing ? for use on smartphones and other electronic devices.
A new app, called Directory for Addiction Treatment in Canada, was just released by Drug Rehab Services, a private addiction referral service. The app lists low-cost and no-cost detox and treatment centres in every province and territory across Canada for people seeking help for alcohol or drug addiction.
It also provides listings of meetings for Alcoholic Anonymous, Narcotics Anonymous and Al-Anon across the country, says Marcelo Gemme, who developed the app as an alternative to his website directory.
The app can also put a user in direct contact with a qualified addictions counsellor, either through a toll-free call or text-messaging.
?The whole idea was to be able to build something that people go there, it?s user-friendly and they find everything they need,? says Gemme, who is located just outside Montreal.
Like a GPS, the mobile app will pinpoint the locations of treatment centres or support meetings within a certain distance set by the user, he says. ?Let?s say if it?s an AA meeting, you?re going to have a pin for every AA meeting within 25 kilometres of where you are right now as you do it.
?If you have a guy who has to travel, this is perfect, because he wants to go to a meeting when he has time off, so it doesn?t trigger anything.?
About 15 to 20 per cent of people seeking help for addictions are now contacting the referral service through a mobile phone, he says.
Watching his four daughters, who ?are always on their phones,? has convinced Gemme that the use of mobile apps for patients is destined to become an even greater part of health-care management and delivery.
?For me, it?s really the future. The mobile, it?s where the technology is going to.?
Dr. Michael Sabel, an oncologist at the University of Michigan who specializes in the potentially deadly skin cancer melanoma, couldn?t agree more.
Sabel and colleagues at the Ann Arbor, Mich., university have developed an app to help patients at high risk for skin cancer keep track of changes in moles and skin lesions to determine if they?ve become cancerous over time.
The UMSkinCheck app, available free through iTunes for iPhones and iPads, involves inputting 23 photographs of various parts of the body.
?For many, many years we had asked patients to get what?s called the total photographic survey, where they had to either go into a dermatologist who offered this or a professional photographer to have some of these baseline images obtained,? he says.
?But the reality is these are very difficult things to do ? to schedule a time to have a full photographic survey. There are costs involved, it?s not always covered by insurance. And even the skin self-exam is kind of difficult for patients.
?We just said to ourselves: ?People are carrying around supercomputers, photography, GPS. Can we use the mobile application technology to help patients in a health-related field???
UMSkinCheck gives the user a reminder to take a new set of photos within a set period of time, perhaps every month or two, so they can compare images of skin areas side by side.
?And now you can really say, ?Hey, look this really hasn?t changed. I don?t need to worry about this.? Or, ?You know what, this has changed. I need to call my dermatologist,?? Sabel says.
The app also includes a skin-cancer risk calculator and photos of the various skin cancers.
Sabel said the team is working on other medical apps, among them one for women being treated for breast cancer.
?My specialty is oncology, but there?s probably a large spectrum across health care where these can be beneficial for patients,? he says.
Sabel says apps such as UMSkinCheck aren?t meant to replace doctors or other health providers. ?We were very careful to say this is an app using the technology to ask people to do things that we already think they should be doing.?
Cafazzo says apps allow patients to engage in self-care, especially when it comes to chronic conditions like diabetes, cardiovascular disease, cancers and respiratory conditions such as asthma.
The cost of chronic diseases in Canada is estimated at $80 billion a year in illness and disability ? a figure sure to grow as the population ages.
?So if we are going to be responsible, we have to think of ways of dealing with chronic conditions such as diabetes and high blood pressure in different ways and give the patients the ability to do self-care, and not increase the burden on the health-care system,? he says.
Nita says the Bant app has given her more than just a means of tracking Marcus?s glucose readings ? a built-in social media component has allowed her to get in touch with other families dealing with diabetes.
?Before, it was such a new thing for us, the whole diabetes thing. The first couple months we were in a panic. We were on auto-pilot, we didn?t know what we were doing. We were afraid if we gave him too much (insulin), we were going to kill him,? says Nita, who created the website www.nitacure.ca to raise awareness and research funding for juvenile diabetes.
?When I found this app, that?s how I actually found the whole diabetic community online ? and that?s helped a lot. There?s always someone there who?s already gone through what I?m going through.?
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