"There's an app for that."
The phrase is so ubiquitous it's a meme, and trademarked by Apple Inc.
In fact there are more than 165,000 mobile applications available for health care, with the largest category for people with mental-health disorders, managing everything from addiction to depression and schizophrenia.
Although in wide use, the efficacy of most of these programs -- software designed for use with a mobile device -- has not undergone rigorous scientific review, said Peter Yellowlees, a UC Davis professor of psychiatry and expert in using technology in clinical settings.
"While patients have access to an exponentially increasing number of apps, the research literature has not kept pace," Yellowlees said. "But this lack of data has not held back the high level of industry and consumer interest."
Only 14 apps for bipolar or major depressive disorder were examined in a recent literature review. And only seven apps had been reviewed for people with psychosis. Those studies found that there was little efficacy, safety or clinical outcome data in the published literature.
But that has not dampened demand.
The American Psychiatric Association is considering how to provide guidance to psychiatric providers, while the U.S. Food and Drug Administration has stated that it will not approach the monumental task.
A commentary published in the Journal of Clinical Psychiatry identifies two options for psychiatrists to choose from when considering apps and other consumer devices for clinical care.
They can decide to not use apps and counsel their patients against using them, because of the limited evidence regarding their utility and efficacy.
But a more real-world approach would be to accept that patients already are using mobile psychiatry apps, and that they are here to stay.
Patients already are bringing apps, sleep-tracking devices and activity-monitoring devices to psychiatrists to ask for a professional opinion on their use, in the same way that many patients bring Internet resources and Google searches to physicians for second opinions.
The commentary recommends a framework that psychiatrists should consider when evaluating all "ASPECTS" of an app: whether the app is Actionable, Secure, Professional, Evidence-Based, Customizable and TranSparent.
"The framework presented here is important, as it offers a flexible tool that clinicians and patients can use together to make more informed decisions about whether to use or not use a smartphone app or other mobile health technology," said John Torous, commentary first author and clinical fellow in psychiatry at Beth Israel Deaconess Medical Center and the Harvard Medical School.
"While both patients and clinicians know the right questions to ask about a new medication or pill, sometimes they may not be aware of all the best questions to ask about an app. With this framework we hope to guide them towards a more informed discussion," said Torous, who also chairs the American Psychiatry Association Workgroup on Smartphone App Evaluation.
Patients will increasingly bring apps into the clinical visit with them, the authors said. Understanding the complexity of evaluating apps is important to allow physicians lead an informed discussion with patients regarding app use.
Other authors are Robert Borland, Harvard Medical School and Stephen R. Chan of UC Davis.
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