In the past few months, I have noticed my news feed populated by reports highlighting new medication adherence apps popping up and even a study evaluating and comparing available adherence apps. As a pharmacist cognizant of my patients difficulty taking their medications on a prescribed regular basis, the exploration of apps that will make a significant impact in this field are of particular interest.

It is hard to argue with the value of increasing medication adherence, especially with data suggesting that non-adherence to medications is costing over $100-290 billion in healthcare expenditures in the US [1,2]. Obviously, this is a problem that needs to be addressed and some are looking towards mobile technology as a solution.

Several of the new apps that are making the headlines include MediSafe, Nightingale, and ZappRx. While the first two are true medication management adherence tools, the last is an app designed to streamline the flow of getting medications at the pharmacy. While the last app does not really alert the patient to take their medication, it is relevant to the issue of patients taking their medication. This is because the problem of non-adherence to medications is multifaceted with numerous etiologies, and it is not as simple as forgetting to take medications.

Research has demonstrated time and again several areas that affect medication adherence among patients [1,3]:

  • Intentional non-adherence stems from patients refusing to take medication, whether due to lack of education, concerns over side effects or interactions, perceived lack of efficacy, and to preserve supply of medications due to cost (e.g. taking every other day or only half a tablet a day at sub-prescribed dosages).

  • Unintentional non-adherence stems from patients who forget to take their medications, have a language or communication barrier, those with cognitive deficiency, misunderstanding of their regimens, difficulty in accessing medications, and cost as well.

Overall, looking at most of the medication adherence apps currently available, most only address the unintentional forgetfulness of patients who realized at the end of the day that they did not take their medication. For that reason, ZappRx stands out as another way of tackling the issue of adherence by trying to help with streamlining access to medications, though, that again is just one form of the problem. Too many adherence apps address one issue alone through one solution.

The creation of an all-in-one app will be difficult if non-coming. As such, prior to just jumping on the bandwagon, the selection of an app addressing the nature of the non-adherence problem will need to be solved. For medical prescribers who are facing patients that are forgetful about taking their medications, there are plenty of options. However, the ones that will stand out will be the ones that possess creative ways to remind and encourage patients to take their medications, capable of handling complex dosing regimens (e.g. tapering, stop dates, and those take every X amount of time), alert caregivers and providers when patients are non-adherent, and feeds data back into a pharmacy and EHR system [4].

Additional features that apps could incorporate would be recording the use of ‘as needed’ (i.e. PRN) medications, so that providers can track the utilization of medications for symptomatic relief (e.g. pain, anxiety). The utility to ensure medication regimens were finished could also be hugely beneficial, such as if a patient finished their Medrol dose pack or Z-Pak.

Several issues need to be addressed before medication adherence apps gain further ground. First, we need to prove that apps can actually modify patients’ adherence to apps through research and identify which patients will benefit the most. By encouraging such studies, we can pave the way for integration of this mHealth technology into direct patient care. Next, we need to address privacy concerns about the tracking of patient information and ensure that there will be no negative repercussions for the reporting of non-adherence (e.g. insurance company tracking through sold patient data via in-app analysis).

This can then increase the benefit of the data collected for not only the patient but also for all those invested in ensuring the patient is taking their medications. Lastly, focus should also concern the creation of apps that can address issues outside of unintentional non-adherence. While this may be a difficult problem, it would be beneficial for many patients.

I heavily encourage developers to reach out to the medical community and engage in the feedback process on their years of experience working with this problem. Also, patients need to be engaged as well to determine their preferences and what will help them based on their perspectives. After all, they are the people most in need and who we want to help. Perhaps through collaborative methods we can develop an app to help negate or at least lessen this burden on society.

Feel free to leave comments and suggestions, and I will leave off with a favorite quote:

Drugs don’t work in patients who don’t take them.”— C. Everett Koop, MD

References:
1. http://www.nejm.org/doi/full/10.1056/NEJMra050100
2. http://www.scriptyourfuture.org/hcp/m/SYF_Campaign_Overview.pdf
3. http://circ.ahajournals.org/content/119/23/3028.full
4. http://japha.org/article.aspx?articleid=1675615 or http://www.medscape.com/viewarticle/782609 (for those wanting access via Medscape)