Smartphone App Improves Medication Adherence for Patients Needing Polypharmacy

A phone application (Perx) was found to effectively increase medication adherence among patients with multiple comorbidities that require polypharmacy to manage, according to a recent study published in BMJ Open.

The randomized control study provides evidence demonstrating that app-based behavioral change interventions can contribute to better medication adherence and produce long-term improvements in select clinical outcomes in adults managing multiple conditions.

“Apps may be a convenient and effective tool to enhance and sustain medication adherence especially between healthcare visits that may be up to several months apart,” wrote the investigators.

Failure to adhere to medication regimens can lead to poor control or disease worsening, which can result in needing more medications or medical interventions and increased morbidity and mortality risks. Polypharmacy often presents an extra challenge to medication adherence because the concurrent use of multiple medications further increases regimen complexity.

Mobile health interventions can be low cost and scalable to assist patients with following prescription regimens because many patients already own a smartphone. However, not much research has analyzed the effectiveness of medication adherence applications and longer trials are needed to determine whether adherence and improved clinical outcomes can be sustained.

The investigators followed patients for 12 months to assess long-term outcomes of using an app-based medication adherence tool. The enrollment period lasted from February 26, 2018 to January 7, 2019 and the study period lasted from March 1, 2018 to February 28, 2020, representing the dates that the first patient started and the last patient finished.

For inclusion, the patients had to be between the ages of 18 and 75 years, have at least 1 chronic disease, use at least 3 medications, and have access to a smartphone. The patients were recruited from the diabetes, heart failure, and dialysis clinics within 3 tertiary hospitals in Sydney, Australia: Royal Prince Hospital, Concord Hospital, and Liverpool Hospital.

Out of the 1412 people analyzed for eligibility, 124 were enrolled in the study, with 95 patients available for analysis by month 12. The patients were randomized 1:1 to the intervention group using the phone app and the control group, with each group containing 62 patients at enrollment and 45 and 40 patients in the intervention and control groups, respectively.

The mean age of the participants was 59.5 years and 58.9% were female. The most common chronic conditions were cardiovascular disease (78.2%; n = 97), type 2 diabetes (75.0%; n = 93), and obesity (64.5%; n = 80). The participants took 6 daily medications on average (range, 3-15).

The intervention group had a greater improvement in medication adherence than the control group at month 2 (coefficient, 8%; 95% CI, 0.01-0.15; P = .025), month 3 (coefficient, 7%; 95% CI, 0.00-0.14; P = .046), and month 12 (coefficient, 7%; 95% CI, 0.00-0.13; P = .044) compared with month 1.

A similar trend was seen among individuals with obesity, showing that the intervention group showed better improvement from month 1 than the control group at month 2 (coefficient, 13%; 95% CI, 0.04-0.22; P = .004), month 3 (coefficient, 12%; 95% CI, 0.04-0.20; P = .004), and month 6 (coefficient, 12%; 95% CI, 0.22-0.18; P = .018).

The app-based intervention was most effective for patients using 3 to 4 medications, showing improved adherence at month 2 (coefficient, 0.19; 95% CI, 0.06-0.31; P = .004), month 3 (coefficient, 0.15; 95% CI, 0.04-0.26; P = .009), month 6 (coefficient, 0.15; 95% CI, 0.04-0.26; P = .006), and month 12 (coefficient, 0.13; 95% CI, 0.03-0.23; P = .008).

Improvements in total cholesterol and low density lipoprotein cholesterol were observed at month 3. Also, improvements in blood glucose were observed and persisted until the end of the trial at months 9 and 12.

There were several study limitations, including that baseline adherence measures were not analyzed, the use of only 1 app-based intervention limited generalizability of the findings, and that the app may not be accessible to people who do not speak 1 of the languages embedded into the app or have internet access.

“More qualitative and implementation studies such as a cost-effectiveness analysis from a healthcare provider perspective may need to be considered to assess and ensure the feasibility and efficacy of the app on a larger scale,” the investigators noted.

Reference

Li A, Del Olmo MG,Fong M, et al. Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomized controlled trial. BMJ Open. Published online August 9, 2021. Accessed August 12, 2021. doi: 10.1136/bmjopen-2020-047041