Digital solutions can offer more than just reminders to improve medication adherence

Why should we care about medication adherence?

Less than half of the world’s chronically ill patients are adherent to their prescribed medication. That means, one out of every two patients with a chronic disease doesn’t take their medication according to their healthcare provider’s recommendations.(1) This is costly for healthcare systems worldwide, affects profit margins for pharmacies, and also harms patients by increasing their risks of morbidity and death. Barriers to adherence and causes of non-adherence are multifactorial—there isn’t a one-size-fits-all solution. The reasons for non-adherence range from systems-level factors, such as fractured continuums of care, to provider-level factors, such as poor patient education and communication, to patient-level factors, such as low treatment literacy and poverty. Given the complexity of non-adherence, there has been limited success in developing simple interventions to improve medication adherence across different illness settings.(2) However, there has been growing investment and research focused on building digital tools to promote medication adherence, with varying degrees of success. In particular, mobile medication management apps have several benefits. For most patients, apps are easily accessible. They also provide flexibility and adaptability because they can be specific to the health system, the provider, and the patient needs.

What mobile medication adherence tools are out there?

There are nearly 1000 free mobile apps available designed to support medication adherence. The three main types of features found in these medication management apps are: interactive patient education via texts and videos; digital reminders like alarms, push notifications and text messages (SMS); and behavioral techniques, such as gamification, adherence tracking, social motivation and accountability. The vast majority of apps focus on a single feature, with as few as 5% providing all three types of features.(3) Furthermore, the overall quality is suboptimal —most apps don’t accommodate patients on multiple medications with different dosing schedules, or track missed or late doses, or send reminders for medication refills.(4) Nonetheless, even single-feature apps can improve medication adherence. In a 3-month study with Medicare patients in the U.S., medication refill rates increased by 15% just by sending patients interactive SMS refill reminders.(5) However more complex medication management apps tend to have greater effectiveness.(6)

Carebook’s digital solution for medication adherence

With a patient-centered, pharmacist-friendly approach, Carebook is evolving its digital solution to improve medication adherence. It targets the most common barriers to medication adherence as identified in our own survey with patients on chronic medications, including low trust in the efficacy or necessity of the medication, forgetfulness, side effects, and more. While a simple reminder system improves medication adherence, our solution is informed by the most up-to-date evidence that prioritizes the needs of patients and pharmacists, and, most importantly, considers the wide-reaching benefits of human engagement.

References

1. Sabaté E, ed. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.
2. Interventions for enhancing medication adherence. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Cochrane Database Syst Rev. 2008 Apr 16; (2):CD000011.
3. Ahmed I, Ahmad NS, Ali S, et al. Medication adherence apps: review and content analysis. JMIR Mhealth Uhealth 2018; 6: e62
4. Dayer LE, Shilling R, Van Valkenburg M, et al. Assessing the medication adherence app marketplace from the health professional and consumer vantage points. JMIR Mhealth Uhealth 2017; 5: e45.
5. Brar Prayaga R, Jeong EW, Feger E, Noble HK, Kmiec M, Prayaga RS. Improving Refill Adherence in Medicare Patients With Tailored and Interactive Mobile Text Messaging: Pilot Study. JMIR Mhealth Uhealth 2018;6(1):e30.
6. Hamine S, Gerth‐Guyette E, Faulx D, et al. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res 2015; 17: e52.