Commentary

EBA: Reminder app improved multimedication adherence in elderly


 

A tablet-based app designed for elderly Spaniards taking multiple medications seemed to improve treatment adherence rates but not clinical outcomes in a randomized controlled study of 99 patients.

The 48 patients in the control group received oral and written information on the safe use of their medications in the 3-month single-blind trial. The other 51 patients took home a tablet computer (either an iPad 2 or a BQ Verne) with a medication self-management app that the investigators created and called ALICE. The app incorporated personalized prescriptions and medical advice from patients’ physicians, showed images of each medication and its packaging, provided alerts and multiple reminders to take a medication, and transmitted monitoring information to a caregiver.

Courtesy Wikimedia Commons/Dvortygirl/Creative Commons

An app designed to help seniors keep track of multiple medications improved treatment adherence rates but not clinical outcomes.

The rate of self-reported adherence (measured on the four-item Morisky Medication Adherence Scale) increased by a significant 28% in the app group and did not change significantly in the control group. The rate of missed doses decreased by a significant 27% in the app group and increased slightly in the control group, reported José Joaquin Mira, Ph.D., and his associates (J. Med. Internet. Res. 2014;16:e99).

The rate of medication errors that involved taking the wrong drug or dose did not change significantly in the app group as a whole but decreased significantly by 41% among patients who had reported making two or more medication errors before the study.

Levels of glycated hemoglobin, blood pressure, and self-perceived health status did not change significantly in either the app or control groups. Cholesterol levels increased by 5% in both groups, which was statistically but not clinically significant, reported Dr. Mira of Miguel Hernández University, Elche, Spain.

"Three months may not be long enough to observe differences" in any clinical effects of using the app, he suggested. On the other hand, it’s unknown whether the app would be effective in the long term.

Of the 99 patients, 72 (73%) took more than five types of drugs per day and 36 were under the care of more than one doctor (36%).

Among the 51 patients in the app group, medication adherence rates at the end of the study were better in the 28 patients who had never used a computer, tablet, or smartphone (55%) than in those who had some familiarity with the technology.

The app users received up to 2 hours of instruction on how to use the app and had a phone number to call for technical support. Support was needed by 30 patients (59%), mostly related to charging the tablet’s battery or restarting the system. Mean satisfaction scores for the app were high (8 out of a possible 10) and 88% of users said the app improved their medication use or helped to a certain extent, with 12% saying it did not help.

The investigators designed the app with input from 23 patients, three physicians, and four pharmacists. "This study should change the expectations of developers and mobile phone companies, encouraging them to develop apps and devices suited to older patients with multimorbidity," Dr. Mira wrote.

Clinical trials of apps to improve medication adherence are in their infancy.

Unpublished results from a separate uncontrolled study of PatientPartner, a mobile game app that offers iterative guidance, suggest that medication adherence improved by 37% (from 37% to 58%) among 100 patients with diabetes who had been nonadherent. Adherence to diet recommendations increased by 24%, adherence to exercise recommendations increased by 14%, and hemoglobin A1c levels decreased from 10.7% to 9.7%, the company that makes the app reported in a press release.

Investigators at the University of Arkansas, Fayetteville, evaluated 160 currently-available medication adherence apps for smartphones in a separate study, ranked them by the desirability of their features, and then tested the top 10 using a standard medication regimen. Their top three picks were MyMeds (free), RxmindMe (free), and MyMedSchedule (part of a subscription system from MyMeds.com), reported Lindsey Dayer, Pharm.D., and her associates (J. Am. Pharm. Assoc. 2013;53:172-181). Though these aren’t clinical outcomes, it gives medical and pharmacy care providers some basis for recommending one adherence app over another, the investigators suggested.

Dr. Mira and Dr. Dayer reported having no financial disclosures.

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On Twitter @sherryboschert

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