A Comparison of the Reliability of Smartphone Apps for Opioid Conversion
A Comparison of the Reliability of Smartphone Apps for Opioid Conversion
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DOI：
10.1007/s40264-013-0015-0
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发表时间：
2013-02-01
期刊：
影响因子：
4.2
通讯作者：
Maxwell, Simon
中科院分区：
文献类型：
--
作者：
Haffey, Faye;Brady, Richard R. W.;Maxwell, Simon
背景 许多医疗专业人员每天使用智能手机应用程序 (app) 来支持临床决策。阿片类药物转换（以等镇痛剂量将一种阿片类药物转换为另一种阿片类药物）在临床实践中很常见，并且对医生来说常常具有挑战性。因此，提供阿片类药物转换工具的应用程序可能是一种有用的资源。尽管医疗应用程序的使用快速增长，但缺乏强有力的监管和同行评审来确保应用程序内容的准确性和可靠性目前是一个令人担忧的领域。方法我们在主要的在线应用程序商店中搜索了提供阿片类药物剂量转换工具的应用程序。我们评估了七种阿片类药物转换剂量计算中应用程序之间的输出变异性，并评估了专业医疗参与应用程序的作者、创建和设计的水平。结果在确定的 23 个不同应用程序中，超过一半 (n = 12; 52%) 没有明确的医疗专业参与，只有 11 个 (48%) 应用程序提供了其阿片类药物转换率的主要来源的直接参考。将 1 mg 口服吗啡转换为口服可待因显示出最大的转换输出范围（中位数 6.67 mg，范围 3.333-12 mg）。 1 毫克口服吗啡转换为美沙酮的范围为 0.05-0.67 毫克，只有 44% 的美沙酮转换应用程序 (n = 4) 评论说转换率随美沙酮剂量的大小而变化。总体而言，35% 的应用程序 (n = 8) 没有警告用户转换阿片类药物时减少剂量的标准做法。有或没有医疗专业人员参与的应用程序之间氢吗啡酮（口服）的平均转换输出存在统计学上的显着差异（0.2256 vs 0.2536；p = 0.0377）。 结论 对于提供阿片类药物剂量转换的应用程序提供的信息的可靠性存在重大担忧，在许多情况下缺乏有关基于证据的内容和同行评审的信息。为了确保患者安全，加强对医疗应用程序的监管至关重要。
Background Many medical professionals use smartphone applications (apps) on a daily basis to support clinical decision making. Opioid switching (conversion of one opioid to another at equianalgesic dose) is common in clinical practice and often challenging for doctors. Apps providing an opioid conversion tool can therefore be a useful resource. Despite rapid growth in the use of medical apps, the lack of robust regulation and peer review to ensure the accuracy and reliability of app content is currently an area of concern.Method We searched major online app stores for apps providing an opioid dose conversion tool. We assessed output variability between apps in the dose calculation of seven opioid switches, as well as assessing the level of professional medical involvement in the authorship, creation and design of the apps.Results Of 23 different apps identified, more than half (n = 12; 52 %) had no stated medical professional involvement and only 11 (48 %) apps provided direct references to primary sources for their opioid conversion ratios. Conversion of 1 mg of oral morphine to oral codeine demonstrated the largest conversion output range (median 6.67 mg, range 3.333-12 mg). Conversion of 1 mg of oral morphine to methadone ranged from 0.05-0.67 mg, with only 44 % of methadone-converting apps (n = 4) commenting that the conversion ratio changes with magnitude of methadone dose. Overall, 35 % of apps (n = 8) did not warn the user about the standard practice of dose reduction when opioid switching. There was a statistically significant difference in the mean conversion output for hydromorphone (oral) between apps with and without medical professional involvement (0.2256 vs 0.2536; p = 0.0377).Conclusions There are significant concerns with regard to the reliability of information provided by apps offering opioid dose conversion, with lack of information regarding evidence-based content and peer review in many cases. It is crucial that better regulation of medical apps is instigated in order to ensure that patient safety is maintained.