The increasing digitalization of society is also having a significant impact on the healthcare market. More and more patients are using health apps. The importance of these new technologies was also highlighted in the World Health Organization's (WHO) Global Strategy on Digital Health 2020-2025.
Under the leadership of Dr. Anna-Janina Stephan, a team from Prof. Dr. Michael Laxy's Assistant Professorship of Public Health and Prevention has now published an umbrella review of available systematic reviews that examined the effectiveness of mobile app-based health interventions in patient populations. The results have now been published under the title "An umbrella review of effectiveness and efficacy trials for app based health interventions" in the journal "npj Digital Medicine". The journal has an impact factor of 15.357.
"We found that there are many reviews that are very broad in scope. So they don't just deal with health apps, but also with telemonitoring, teleconsultation and many other different types of interventions. These all relate to the digital sector in some way, but cannot necessarily be lumped together," explains Dr. Stephan, Research Associate at the Assistant Professorship of Public Health and Prevention. "From our point of view, what was missing was an overview of existing systematic reviews that deal specifically with the effectiveness of health apps. Sherry On Ki Chong as first author and Nancy Abdelmalak in particular invested a lot of time and effort in the creation of this umbrella review."
Building on preliminary work from a master's thesis, 48 systematic reviews (35 of which included meta-analyses) from the period 2013 to 2023 were examined that met the inclusion criteria for the umbrella review. With the increase in available health apps, the number of scientific classifications and assessments of their efficacy and effectiveness has also increased over the last ten years. "Since 2019, the Digital Healthcare Act has made it possible for the first time to prescribe app-based healthcare services within the statutory health insurance system in Germany. However, this is also accompanied by requirements defined by the legislator if the costs of using a health app are to be covered by health insurance," says Dr. Stephan. "To achieve this, the apps must provide very good evidence of effectiveness, which is usually generated by randomized controlled trials. This is why there are now a very large number of high-quality efficacy evaluations."
Eleven of the included systematic reviews dealt with a wide range of diseases, thirteen studies focused on diabetes and five others on anxiety disorders and/or depression. A significant proportion of the reviews attempted to cover multiple indications simultaneously, or made no specific restriction to particular diseases.
The included studies covered populations from all continents, with the majority of data collected in high- and middle-income countries such as the USA, China, Australia, the UK, Spain, Norway and Japan. The samples ranged from 282 to 7,669 patients per study.
The health apps analyzed offered a wide range of features, including symptom monitoring and assessment, medication reminders, real-time biofeedback, personalized programs and education, tailored motivational messages, and communication with healthcare professionals.
Of the reviews included, 41 concluded that health apps can be effective in improving health outcomes. The seven analyses that did not find effectiveness reported inconclusive results or clinically irrelevant improvements. In principle, the available systematic evidence on the effectiveness of app-based health interventions varied widely between indications. In addition, measures of health resource utilization such as frequency of doctor visits or hospitalizations were rarely reported. This results in knowledge gaps of how health apps affect health outcomes, how long their effect lasts and what economic burden or relief this places on healthcare systems in terms of healthcare utilization.
Therefore, the Assistant Professorship of Public Health and Prevention recommends recording behavioral outcomes and measuring the use of health resources for future randomized controlled trials. This would make it possible to gain better insights into the mechanisms of which health apps are effective and to shed more light on their impact on healthcare systems.
"The Umbrella Review provides a helpful and easily accessible guide for policy makers, clinicians and patients to find relevant, summarized evidence and an assessment of the quality of studies," explains Prof. Laxy. "The results provide a good basis for identifying and improving app features and functions that have a decisive influence on efficacy in the next step. After all, effectiveness is one of the most important parameters for ensuring a good balance between the potential benefits and the required investment and costs. This ratio is necessary in order to be able to offer new health apps to as many patients as possible within the available resources in the healthcare system."
To the publication „An umbrella review of effectiveness and efficacy trials for app based health interventions“ in the journal „npj Digital Medicine”
To the homepage of the Assistant Professorship of Public Health and Prevention
Contact:
Prof. Dr. Michael Laxy
Assistant Professorship of Public Health and Prevention
Georg-Brauchle-Ring 60/62
80992 München
phone: 089 289 24977
e-mail: michael.laxy(at)tum.de
Dr. Anna-Janina Stephan
Assistant Professorship of Public Health and Prevention
Georg-Brauchle-Ring 60/62
80992 München
phone: 089 289 24984
e-mail: anna-janina.stephan(at)tum.de
Text: Romy Schwaiger
Photos: “npj Digital Medicine”/Astrid Eckert/TUM/private