In a first-ever systematic review and meta-analysis, researchers discover that mobile apps may help patients take their medication as prescribed and agreed upon with their healthcare providers.
The extent to which patients follow agreed upon prescription is referred to as ‘adherence to medication’. Non-adherence may lead to disease progression, a lower quality of life, and more hospital visits, among other consequences. There are various factors that may contribute to poor medication adherence. For example, patients may not understand the health language used by the doctor in the prescription, which could be due to language barriers or the prescription being very complex. Remembering to take the medication at the right time may also be an issue. In some cases, patients who are not convinced of the need for treatment or are afraid of the negative side effects of the drug may intentionally not adhere to prescription instructions.
Not surprisingly in this modern digital age, hundreds of mobile apps have been developed to help patients take their medication. Frequently, apps use behavior change techniques to elicit adherence behavior from the patient. Behavior change techniques include prompts and cues from the app such as reminders for taking the medication or when the app provides feedback on patient behavior. The effectiveness of these mobile apps has not yet been extensively studied.
Recently published in BMJ Open, researchers conducted a rigorous systematic review of previous studies (database) from 1990 – 2018, isolating those that investigated the use of an app on a mobile device (smartphone, tablet computer, or personal digital assistant) to support medication adherence. Key search terms included adherence, non-adherence, smartphone app, and randomized controlled trials (studies where participants by chance either received a mobile app intervention or were part of the control group which did not). Two reviewers independently screened the studies. Any discrepancies in the screening process were settled through discussion between the two reviewers and a third reviewer.
From 13,259 citations in the initial database search, nine randomized control trials with data on 988 participants met the criteria to be included in the meta-analysis (a statistical procedure for combining data from multiple studies).
All nine studies were published between 2014 and 2018. In eight of the studies, the mean age of participants in the app intervention group ranged from 20.3 to 73.8 while one study did not report the mean age. Across these eight studies, the average of the mean ages was 56.7 years. Health conditions of participants in the studies included cardiovascular disease, depression, Parkinson’s disease, psoriasis, and multimorbidity.
Six of the nine studies used self-reported medication adherence scales. Two studies reported adherence according to pill count and one study used a digital chip record fitted within the medication dispenser.
Mobile apps for medication use found to be effective for medication adherence
Mobile app interventions were found to be effective in supporting medication adherence in each of the nine studies, although five studies did not report a statistically significant effect. This difference in effect size may be due to variation in adherence measurement, unaccounted for behavior change techniques used by the apps in the studies, or participant-related factors such as non-adherence behaviors and disease burden.
A meta-analysis of the pooled results from the nine studies indicates that patients who used mobile app interventions were more likely to adhere to prescribed medications. However, since six of the nine studies used self-assessment scales, potential bias and recall errors are possible.
Meta-regression analysis of the behavior control techniques did not reveal any significant associations between the techniques used and adherence to medication (size of observed effect).
The researchers note that the long-term effect of mobile apps for medication use and adherence is unknown because of the short follow-up period of the nine studies.
Furthermore, larger-scale studies are required to confirm the results of this meta-analysis since the sample sizes in the nine studies were small.
Given the prevalence and accessibility of mobile apps in our society, more studies are needed to fully use today’s technology for improving healthcare.
Written by Maria-Elena Bernal
Armitage LC, Kassavou A, Sutton S. Do mobile device apps designed to support medication adherence demonstrate efficacy? A systematic review of randomised controlled trials, with meta-analysis. BMJ Open 2020;10:e032045. doi: 10.1136/bmjopen-2019-032045
Jimmy, B., & Jose, J. (2011, May). Patient medication adherence: measures in daily practice. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191684/
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