The increasing adoption of mobile health (m-health) technologies has the potential to reduce disparities in renal care, but experts say a digital divide limits current effectiveness.
The term m-health refers to the use of mobile technologies—cell phones, tablets, and other devices—to help patients connect with health care professionals, report symptoms and medication use, and adopt treatment recommendations. Physicians say m-health has developed rapidly as a subsegment of the growing electronic health field, often referred to as e-health.
"Using digital tools, we are better able to identify people who are at risk and engage them as part of the health care team," says Clarissa Jones Diamantidis, MD, a researcher and clinician who has dual appointments in the Duke Divisions of Nephrology and Internal Medicine.
An advocate for m-health who employs digital learning tools for her patients, Diamantidis encourages the development of future m-health programs that address gaps in digital readiness, financial resources, and health literacy.
She says that the growing use of smartphones to access information online, including health data, presents opportunities and challenges. Limits on phone data, small screens, privacy risks, and the potential to misunderstand abbreviated text messages hinder effectiveness.
But, because ethnic and racial minorities are the most active users of the mobile web, m-health tools can be useful to nephrologists to increase patient engagement among these groups, particularly as mobile applications improve.
"Providers and developers need to be aware of the disparities in the patient population with chronic kidney disease and address them with evolving technologies," Diamantidis says.
Some literature suggests that African American and Latino patients express a preference for a personal relationship with a doctor over the use of a mobile connection—a significant finding that emphasizes the need for ongoing nephrologist–patient interactions to optimize the likelihood of improved health outcomes.
Recent studies in long-term disease show that patients using mobile technologies to access health care professionals report more consistent monitoring of symptoms and higher rates of medication adherence—key factors in the management of chronic kidney disease and related kidney conditions.
Certain population segments have a greater likelihood to benefit from mobile technologies, Diamantidis says, and the benefits relate to what she describes as "digital readiness." Patients older than 50 years are most vulnerable to kidney disease, but they also tend to represent the digital divide—patients who are less willing to access learning tools in web-based applications and less likely to benefit from new technologies.
In Diamantidis' studies, she uses a tablet application to educate patients at risk about their kidney health. "We pose questions on the tablet that are critical to patient awareness," she says. "'Has anyone told you that you might have kidney problems?' 'What kinds of medications do you take?' 'Are your medications safe for you?' We want patients with kidney disease to feel engaged in the treatment of their condition."
She continues: "As our tools and applications improve, this type of engagement can be accomplished through m-health and we will reach many more at-risk patients."