I’m looking for studies that show differences in record keeping “compliance” when we compare paper log books to mobile apps.
Maybe people keep records for a Doc appointment over a two week period. Diabetics seem like the natural place to start. But, none of us keep paper log books anymore (except for me). I’m wondering about cardiac patients, who will lean older.
Do we expect a difference in compliance with record keeping when people use paper logs versus an app?
Do older people want paper log books? Maybe 10 years ago they did, but not now, right? Who wants paper logs, anymore (except me)?
Found it. There’s actually a TON of people who only use paper records and never go on the internet. A bunch of people with disabilities and a chunck over age 65. That’s interesting.
Very interesting. But I bet the quantity of people that use paper to track are a lot less for type 1’s and possibly type 2’s. Both have more access to a CGM and a lot of the glucose meters that are “newer” also can download their information directly into a computer. Potentially blood pressure readings would be taken off a meter too. I don’t think the other chronic conditions like those listed necessarily have those kind of tools. So their paper tracking might be a lot higher for things like sleep and headaches.
Of course the health tracking study was for 2013 that I read and I’m sure those stats have changed. The mobile device use was 2021. It is interesting that people with a disability are less likely to own a computer, phone etc. But that might be strongly linked to older adults that are more likely to not own a device in the first place and are the ones most likely with disabilities.
I think each person should do what works for them, and how/what they choose to manage/track.
I have never used food logs/diary, but some find them very helpful.
With pump and cgm in 1990s, I pretty much stopped doing any written logs. Pump/cgm data can be reviewed if needed, and A1C testing at each Dr appt usually gives doctor what she wants, and we discuss items that I suggest. For me, reviewing past logs has little value.
How many times have you eaten the same thing, same insulin dose, but vastly different results?
There are too many factors that influence BGs and daily total insulin. Just have to learn how to be prepared and go with the flow, or for those that prefer, try to go with what is more predictable.
2 years ago when I became aware that my fBG and postprandial BG was inching up I began keeping an extensive log of grams of fat, protein, carbs and calories - also, glucometer readings for fBG, postprandial and bedtime, and exercise.
It became evident to me and my PCP with the added full percent rise of HbA1c in 3 months that type 2 DM had progressed to me needing to go on MDI in addition to Lantus and Metformin.
I don’t keep paper or Excel logs since I have tracking apps with Dexcom, Tandem and the Plus app that is also used to order CGM supplies.
I need data collected by patients on cardiac symptoms, so there will be a lot less data keeping. But there is still debate on if patients will record keep over a two week period. I’m certainly biased that people will do it because of the amount of analysis this community does.
I read a big fifty page report last night on, “Mobile Health Applications for Self Management of Diabetes.” It wasn’t great. The Apps they evaluated were not commonly used apps. There weren’t any people over 65. Insulin pump people were excluded. There’s surprisingly little reliable data on patients using mobile apps to collect data. The report says almost all the studies they evaluated are of poor quality. Bummer.
I don’t know how to measure “compliance.” One way might be to see if people respond to random communications generated by an app. But people are providing so little data, over such a short period, that it’s not going to be a good estimate of someone’s likelihood to report a single rate event that may or may not occur.
When the data was for me, something I wanted to solve. I was good at record keeping. But when it was time to give something to the doctor and was more in depth of their requirements, even if just for a few weeks, a lot of making up numbers and guessing went on. Maybe the first couple of times I was very good at it.
In fairness it’s not an easy task, to remember to make a note at the time, to keep track of the data they want, when they want it etc. So then you look at a chart that is supposed to be filled in, after the fact… and you don’t want to present it to the doctor empty… However we are talking blood sugar numbers which are a constant thing all day, every day. So I would suppose if you are just asking if something happened on any particular day it might be different. Short term, a couple of weeks for a cardiac patient to help them might be different. Long term I think is always problematic, who wants to voluntarily add more work to their life permanently easily?
And this is not to include everyone old. Some people are more exposed to newer tech than others which makes it easier. But some older people are just not used to tech and as you get older you just don’t always want to bother. I can tell you my Dad at 80 wouldn’t use the computer we bought him. We got my mother in law to use one that she uses just for e-mails. But when his sister gave her a smart phone instead of the flip phone she had, she literally smashed it she got so aggravated at it. She is back to a flip phone.
And in both of these cases, we are the ones that wanted them to use something. Not something they were interested in and that makes a difference.
I am not sure what record keeping compliance is. Lol. My doc does not require any but I used to do reports when I went there. Cde uploads my dexcom, they could not do my pump for some reason.
The woman at the front window last time thought I was gonna give her my pump to download it because it would take a long time, while I waited.
lol what does she thinks gonna happen to me while I am sitting there with no pump on WTF?
It would help if we knew why you wanted to have the comparison information.
eg. Are you just curious? Is it for a report? Are you unsatisfied with what you get back when you ask a patient for a log?
For a single two week record by any person, ease of use would suggest a simple letter size sheet printed both sides. That would provide enough space for entry, work with a pen or pencil. It could be folded to fit a pocket or purse, or stuck in a refrigerator, It would be cordless, wireless, and be independent of operating system connectivity and power. Thoroughness and accuracy of record keeping is an entirely different matter.
Symptoms detectable by patients are gross effects that can be caused by things other than cardiac issues. A person with neuropathy may not notice something that is clearly evident on an ECG. You can not rely on any patient to provide the data you seem to want.
In 2022, if you need reliable comprehensive cardiac data that is meaningful, then wire up those patients with monitoring appliances, not apps. Do continuous monitoring and give them a push button to add an event marker when they notice something. Have the recordings screened by a professional app.
Imo, a person who doesn’t keep a log that is clearly useful and intended to improve their health and care either doesn’t believe it or doesn’t understand. If you can’t convince them or help them understand that, you will be ineffective in communicating patient self-care.
Your generalization that older people are not used to tech and won’t adopt new tech of actual value is wrong. . They’ve experienced more new tech and tech fads during their lives than young people and will use any intelligently designed device that can improve their lives.
What I have seen is that when people get closer to their end of life, they have a clearer understanding of the utility differences between important, new, valuable and better.
I’m an engineer. I understand computers better than 99% of the people who own a device with a computer in it. I use a laptop, smartphone and tablet.I understand human factors and process design and organization social behavior.
Today’s Smart"phones are badly designed swiss army computers with very poor user interfaces. They are worse as phones than the cellular phones of 20 years ago. They are worse as automatic cameras, worse as the same guts packaged as a laptop with a physical keyboard.
None of them are designed to be used by people with any physical impairments. All of them are capable of doing more than any one person needs, with every function performed poorer than devices each optimized for a smaller number of functions over generations of development and feedback. Smartphones are developed in a near-vaccum to fit additional dubious value functions and “higher performance” into a form factor that is thin, fragile and awkward for a species that evolved to use a solid durable round handle grasped in a closed fist.
Your mother in law would rather use an almost comfortable-to-hold-flip phone with buttons and a decent loudspeaker function than try to swipe a screen covered with things she doesn’t need answer a call - because she has experience with a better phone design.
Your 80 year old Dad would rather spend 5 minutes hearing your voice than spend 15 minutes at a computer, badly keyboarding a one-sided message that is begging you to call him between the lines. He doesn’t want to sit alone in front of a computer,writing or reading email; he wants to be with other people. He thinks that “social media” is anti-social- and he’s correct.
I am totally onboard with you on this one. I am also in my mid 70’s and our global corporate IT teams report to me. My mother is almost 101 and would be lost without her iPad. I don’t do social media as I would rather spend the face to face time with real people, than people trying to make themselves be more than they are behind a keyboard.
@pstud123 I purposely said some older people. If you are not exposed to it, you are not used to it. When you retire and the kids move out, you are not being exposed to all the latest and newest as much. And the fact it makes a difference if they are pursuing it for their interest or someone else’s. I know plenty of elder veterinarians, dentists, acupuncturists that have adopted newer tech to use in their practice.
@pstud123 Also making statements about my Dad maybe because of your personal experiences with maybe your mom is also wrong. I drove 60 miles weekly to visit my Dad when I was very busy and owned my own business. The computer was set up for him all the time and he wouldn’t use it. He used to love to read about past military type information as he was in the Air Force for 25 years. It was to help him add to the enjoyment of that. He also was definitely not social.
I still say there is a segment “some” of older people that aren’t as likely to learn and use tech. That plays out with the fact as ownership of certain “newer” tech goes down as people age. That is not meant to be inclusive of everyone older. My mother in law happens to hate anything new or different.
There’s actually not very much study on the use of cell phones to collect patient data and the reliability of that data is kinda all over the map with small study sizes. A lot of the results are deemed to be worthless because of poor study controls. Then, the studies ON those studies are also kinda poor.
Thanks for everybody’s feedback.
When studies aren’t available, I just ask you all and tend to some meaningful perspective.
The only stuff I found, in writing, was that there is a much lower incidence of snartPhone use among people 65+. But, for older patients who collect data using a smartPhone, it tends to be more “honest” and complete.
There are problems collecting reliable mobile data from both the very young and the very old. The young tend to not adhere to the practice of data keeping, whereas older people tend to not use the device at all. While I’m certain there’s an overlap between older adults and disibility and smartPhone use, there’s not a lot published.
I prefer flip phones because when I can’t see, I can still feel the buttons and dial 911. But, I use a Smartphone. I’m middle aged. REALLY an old school dial phone is best for calling 911 - the older, heavier, and more indestructible the better. You want a phone that’s like a tank in a medical emergency. I want a phone that I could throw at a home invader and knock them out cold. Those are my fav.
I use paper and digital. The digital comes from Dexcom clarity which I down load and send to different physicians. Yes I know I can give them excess to clarity .
I also write down my glucose readings every three hours from Dexcom this is added to to my BP weight And temp daily, that is up loaded to my home heathcare worker’s database with the V.A.
and I do not log dietary info anywhere.
No way I am taking it off for 15 minutes or longer so they can download it. She made it sound like it would take longer than that also, for them to download it. That is too long for that, it does not take 15 minutes for me at home. When I do it at home I don’t disconnect. I never do it anymore because I never look at the records myself and no one requires it at my endo, and they don’t seem to care that I stopped emailing my records which I only did before my appointment anyway.
My cde usually looks at it when I meet with her and it has never taken more than 1-2 minutes if she does. Last few times she could not log in to my area so she did not even do that.
The only time I take it off for that length or longer is if I am getting a test that requires it then I bolus a little dose to cover it. I often jump up when I take it off to shower so I should be bolusing a little bit for that too, it depends what’s going on. I noticed when I do bolus a little bit it stops me from jumping up.
