Improving Medication Adherence Through Smartphone Apps

Elizabeth So, Pharm.D., MBA, Cub Pharmacy

Medication nonadherence is a common and costly problem, occurring in about 50% of patients on chronic medication therapy and accounting for $100 billion in annual healthcare costs. Various methods to improve adherence have been studied, with most attempting to change patient behavior by using traditional reminders. While traditional reminders such as weekly pill boxes are helpful, they only passively remind patients to take their medications and can be cumbersome for complex regimens.

Smartphone adherence apps present a novel approach to improving adherence. Apps can easily be implemented as they are inexpensive, accessible to anyone with smartphones, and do not require separate devices or packaging. Features of adherence apps include reminders that can be set for consumption and refills, doses that can be logged, and data logs that can be shared with providers. Although there are limited studies on the efficacy of apps on adherence, text messaging, which uses similar prompts to apps, have been shown to improve adherence and behavior.1

One study evaluated the features of medication adherence apps across the operating systems Apple, Android, and BlackBerry during August to September 2012.2 A total of 147 unique apps were identified. To identify apps with the most utility for patients, the authors created a list of desirable features and ranked them by perceived importance to user desirability. Desirable features included online data entry, scheduling of complex medication instructions, cloud data storage, searching and entering medications using auto-population, syncing, exporting, and printing capabilities, tracking of missed and taken doses, provider input, availability on more than one operating system, free-only apps, generation of reminders with no connectivity, statement of HIPAA compliance, multiple profile, and multilingual capabilities. The 10 highest-rated apps were installed and tested by two authors using a standard medication regimen. A total of six apps met or exceeded manufacturer claims, with the majority being intuitive, easy to use, and providing satisfactory medication reminders. Among all apps, MyMedSchedule, MyMeds, and RxmindMe (no longer available) rated highest due to enhanced levels of functionality.

Apps with functionality beyond a simple reminder system, such as maintaining medication regimens through “pushing” to patients’ devices and the ability to export taken and missed doses, offer advantages for pharmacists and providers. The biggest limitation to medication adherence apps is that they can only be used by individuals who have access to a smartphone. In addition, very few apps are interconnected with information systems such as electronic medical records. This prevents pharmacists from customizing reminders for patients with adherence difficulties and ensuring the accuracy of manually inputted prescription data. Medication adherence apps have the potential to improve patient adherence during medication therapy management in community and ambulatory care settings.

References:

1. Vervloet M, Linn AJ, van Weert JC,  et al. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. J Am Med Inform Assoc. 2012;19(5):696–704.

2. Dayer L, Heldenbrand S, Anderson P, et al. Smartphone medication adherence apps: Potential benefits to patients and providers. J Am Pharm Assoc. 2013;53:172-181.