Evidence
Alert

Apps to help patients take medication on time need to be evaluated in a consistent way

Patients who used apps to remind them to take their medication were more likely to say they took it as prescribed. A review found that patients were twice as likely to say they followed the information given by their prescriber (adhered to their medication) if they used an app.

Taking medication as prescribed is important to maximise its benefits for patients, and to avoid costs to the NHS. 

Mobile apps could be a convenient and inexpensive tool for increasing adherence to medication. Patients could consider using currently available apps. However, a consistent method is needed to assess adherence and the value of apps before they can be recommended by healthcare professionals.

What’s the issue?

Roughly half of all patients do not take their medications as prescribed. This leads to poorer health for patients and additional costs for the NHS. The Department of Health estimated in 2014 that non-adherence adds £930 million per year to healthcare costs in England.

Any interventions to improve adherence must be reliable and convenient. There are many apps available  but their effectiveness has not yet been evaluated thoroughly.  This review could inform large-scale research.

What’s new?

This study is part of the Programme on Adherence to Medication (PAM), a 5-year NIHR programme designed to develop a convenient and low-cost intervention to support adherence to medication. The researchers reviewed existing research into patients’ use of apps to help them to take medication as prescribed. They pooled data from nine relevant studies which included 1159 patients in total. The patients had a range of disease types and were using a range of medications and apps.

Overall, patients who used reminder apps were approximately twice as likely to say they took their medications as prescribed compared with those who did not use apps. All nine studies reported that their app-delivered interventions were effective. However, the effectiveness of apps varied from study to study, and in five studies the interventions had only a small effect that was not significant. 

There are several possible explanations for the variation in performance of the apps.  It could be due to differences in the patient groups. Older patients may feel less confident using apps, for example, and patients with more severe disease may be more motivated to keep using their apps. 

The methods used to measure adherence varied across studies. Some methods are less reliable than others; memory may not be reliable when patients self-report and they may answer in the way they think is expected. The difference in effectiveness could also be explained by differences in the apps themselves. It is possible that apps which are more personalised to the individual, for example using artificial intelligence to include tailored information such as a patient’s beliefs about taking medication, mood, quality of life, age and disease duration, were more effective than others that were less personalised. 

Why is this important?

Non-adherence to medication leads to harm for both individual patients and healthcare organisations. Apps are convenient and may be effective in increasing adherence.  However, current guidance from the National Institute for Health and Care Excellence (NICE) recognises that no specific intervention can be recommended to increase medication adherence at present. NICE states that any suggested interventions should be tailored to an individual patient’s needs. 

This study suggests that apps could soon present a modern-day method to personalise interventions to increase adherence. 

What’s next?

Future research is needed to establish:

  • the effectiveness of apps in a greater number of patients
  • a reliable and objective method of measuring adherence
  • which characteristics of apps make them effective
  • over what period of time apps are effective. 

The results of this review are being used to inform future research and have been used in the development of an adherence app, which is currently being tested. 

You may be interested to read

The full paper: Armitage LC, and others. 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

Related research on medication adherence at the University of Cambridge

National Institute for Health and Care Excellence (NICE) clinical guidelines on medication adherence, published in 2009 and reviewed in 2019

Conflict of interest

The researchers declare no conflicts of interest.

Funding

This research was funded by the NIHR Programme Grants for Applied Research and NIHR’s Collaboration for Leadership in Applied Health Research and Care (CLAHRC).

Commentaries

Study author

Poor medication-taking is a widespread problem. We believe it is important that the public, patients, researchers and policy-makers all join in the conversation and debate about how we can improve people’s medication adherence. Helping people improve how they take their medications would lead to improved control of their health problems and substantial financial savings for the NHS.

Laura Armitage, Clinical Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford

Clinical lead, ORCHA

There are so many apps out there. Everyone wants to customise and potentially commercialise their app, and some are better than those that are coming out top. Not all have been through enough trials to see if they make a difference compared to standard care.

App development needs to come together so that there is consistency and quality that is presented to the clinical community without bias. However, the diversity of creativity and solution-finding should not be stifled. There needs to be more clinician reviewing and user feedback in a more structured way. Some work has been done on establishing an objective, agreed way to evaluate apps, such as that done by the Organisation for the Review of Care and Health Applications, ORCHA.

One of the biggest issues will be actually getting these apps to be 'prescribed' by clinicians – people still do not see apps as a solution and they aren’t prescribed as much as they could be.

Frank Joseph, Consultant Physician in Endocrinology, Diabetes and Internal Medicine, Countess of Chester Hospital, & Specialist Clinical Lead at ORCHA

Digital health specialist

There is fragmentation in the digital health technologies market. It is vital for integrated care systems to partner with leaders in digital health technology development to provide clarity on regulations, value proposition and best practice.

In Dorset, we are aware the market is awash with apps and wearables and it is a real challenge to know whether products have an impact and improve health. We have partnered with ORCHA to ensure that the apps on our site have undergone a rigorous review process involving clinical assurance, user experience and data protection. It means that our workforce can safely recommend proven technologies, and it gives the public the information they need to choose.

Experience has shown that even the best technology will not be adopted if the user experience is poor and its purpose is not clear. Unconscious bias shouldn’t play a part in offering digital health technology to patients. The unfortunate situation with COVID-19 has turned expectations of adoption, and ageism, upside down. Prior to the pandemic, less than 40% of those offered a digital-first approach to long term condition management accepted it. This is increasing. This is a pivotal time in the digital-first movement and I am excited to see how it evolves.

Crystal Dennis, Lead for Digital-Empowered Self-Care, Our Dorset Integrated Care System

Researcher

Decisions as to whether or not patients use apps remain ultimately in their hands. The current recommendation could be that if patients wished, they could use an app to help with self-management and if they did, this is likely to help with their adherence, but the success of this will vary depending on the individual, the app and the condition.

Healthcare workers such as GPs and community pharmacists, or health policy makers, may wish to encourage app usage. However, these findings are currently limited in their generalisability and more research is needed before wider conclusions can be drawn. A practical next step could be to create a list of recommended evidence-based apps, which could include the apps reviewed here.

Amy Chan, Senior Clinical Research Fellow, School of Pharmacy, University of Auckland, New Zealand