In this edition of Tech Notes, we’ll cover a medical app from the Centers for Disease Control and Prevention (CDC) that’s essential for the current opioid epidemic, an app from the American College of Cardiology, and an app that helps providers do quick and minor procedures at a patient’s bedside.
Every healthcare provider is currently aware of the opioid epidemic gripping our nation. Many of us see this on a daily basis with patients who come in for overdoses. It has become common to administer naloxone to patients who come into the emergency room with decreased mental status. Per the CDC, overdose deaths involving opioids, including prescription opioids, have quadrupled since 1999.
To help physicians manage this crisis, the CDC released the "CDC Guideline for Prescribing Opioids for Chronic Pain" in 2016. These guidelines were meant to help physicians treat chronic pain in patients who are outside of active cancer therapy, palliative care and end-of-life care. The guidelines address when to initiate opioid therapy, the types of opioids to choose, and how to assess the risks and harms of prescribing opioids.
At the end of 2016, the CDC released a medical app called CDC Opioid Guideline, which condensed the recommendations the CDC had made earlier in the year pertaining to chronic opioid management. The app itself offers some great features. One of the favorites is the morphine equivalency calculator and a subsection that explains how to use motivational interviewing with chronic pain patients.
I can’t overemphasize the importance of the app’s motivational interviewing section. It gives physicians the opportunity to use evidence-based techniques for behavior change. The techniques have been proven to reduce the risk of opioid misuse, increase patient motivation to change, and decrease depression in the setting of opioid use.
This app is a must-have for primary care physicians and other physicians who prescribe opioid therapy on a daily basis.
Key ways to use this app: If a patient presents with chronic pain, use the app to determine if their medication dosing should be changed, or if they are at risk for opioid addiction. Use the morphine equivalency calculator to determine conversions for opioid therapy. Use the motivational interviewing section with patients. It’s a patient-centered approach to encouraging behavior change.
The American College of Cardiology (ACC) is one of the most active medical societies in the mobile space. The DAPT Risk Calculator is one of their latest medical apps and continues the association’s trend of producing useful and free medical apps.
Duration of Dual Antiplatelet Therapy (DAPT) is a big deal for patients who undergo cardiac catheterization procedures. While the length of DAPT after bare metal stents and drug-eluting stents is well established, guidelines aren’t as clear on what to do after 12 months.
Serious harm can arise from continuing antiplatelet therapy, such as gastrointestinal bleeds. The DAPT score, developed from the DAPT study randomized trial data, helps physicians determine whether or not anticoagulation therapy should be continued based on a patient’s comorbidities and stenting characteristics.
Though there are online calculators for this, having it available at the point of care provides ease of use and helps you go over the score with the patient as well.
Key ways to use this app: This app helps family physicians and cardiologists decide whether or not to continue antiplatelet therapy after 12 months.
Having a medical app that helps you with both learning and refreshing your medical procedure skill set can be very useful. Proceducate is a medical app that fills this role. The app is focused on procedures encountered in the primary care setting and would also be useful for urgent care providers and emergency medicine physicians.
The great thing about the videos and explanations is how abbreviated they are, enabling them to be used at the point of care to refresh on anatomy or key parts of the procedure. The app is part of a research study at the University of Toronto that is looking at how to best integrate mobile applications in learning and teaching.
Proceducate isn’t a great app to use if you’re just learning a procedure; for that, you need formal training and to see several being done. But it’s a great tool to use if you have already learned a procedure and want to reinforce and learn some of the finer points, or if you need to refresh your memory on a key part. The following are key procedures discussed in the app: suturing, cryotherapy, biopsies, toenail management, aspiration/injections, IUD insertion, speculum exam and perineal laceration repair.
For almost every procedure, there is a short video along with the following information: indications, risks, equipment needed, detailed review of the procedure and various steps, complications, and references to where the procedure steps were sourced.
Key ways to use this app: There is often not just one way you can do a procedure. Use this app to learn a variation on a technique or to refresh your memory of any key part.
Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine.