What do you use your cell phone for on a daily basis? Many people would say using social media, texting, and placing phone calls– but have you ever considered your smartphone as a tool to improve medication adherence? Our phones are an integral part of our lives, and consequently, researchers, clinicians, and patients have all been exploring ways to harness the power of mobile technology to improve health outcomes.
Further, with the increased adoption of smartphones, there has been a simultaneous explosion of health focused mobile applications (apps). A report from the IMS Institute for Healthcare Informatics counted over 165,000 healthcare apps available for download, many of which can be used to improve adherence for patients taking daily medications.
Why is medication nonadherence a problem?
Medication nonadherence is a significant barrier to disease management, with estimates of nonadherence ranging from 25% to 50% depending on factors such as disease, insurance coverage, and patient characteristics. Medication nonadherence also affects health outcomes and healthcare costs. The US spends $100-$300 billion annually on avoidable health care costs due to nonadherence. In response to the costs and poor health outcomes, various tailored interventions have been developed and tested to improve poor medication adherence including electronic pill boxes, text messaging, online interventions (such as assessments), and counseling. However, despite these efforts, we still need additional tailored and effective tools to improve adherence.
How could mobile phone apps help?
The prevalence of smartphone usage has dramatically increased over the past several years. Presently, 77% of US adults own a smartphone, which is a big jump from the 35% who owned a smartphone back in 2011. With smartphone use on the rise, Dayer and colleagues published a 2013 article about the potential benefits of mobile apps: they are relatively inexpensive, easily accessible, available 24/7, can provide tailored reminders (both for dosages and refills), and can function as a repository for medication and user-specific information. The study identified 160 different medication adherence apps, and another study from 2016 identified 272 different medical apps that offer a medication adherence feature.
What are some potential barriers?
While medication adherence apps do offer a lot of benefits, before downloading the first medication adherence app that comes up on your smartphone, there are a few important factors to keep in mind. First, there’s not a lot of research out there on the effectiveness of adherence apps. A recent article in the Journal of Medical Internet Research: Mhealth and Uhealth discusses how sparse the literature is on adherence app medication reminder systems for specific populations or specific disease states. Additionally, the general effectiveness of smartphone medication adherence apps for those with chronic conditions is still unknown.
Next, app quality may be questionable. The 2016 study that identified the 272 medical apps discussed how the majority of apps didn’t have a number of desirable features (such as refill reminders, medication tracking, a medication database, data security, and others) and were thus considered to be low quality. A search of the term “medication adherence” on our smartphones came up with dozens of possible apps, many of which had no reviews and no definite way of making a judgement call if the app was high quality or had helpful features. Finally, another notable issue is data security. A person’s health information is sensitive material, and privacy policies for mobile health apps may not keep up with evolving technology, may be unclear, or may not even exist.
Where do we go from here?
With the lack of peer-reviewed evidence of effectiveness, patients are left to look for other sources. A recent special report from Consumer Reports looked at 11 widely used medication tracking apps, and while many were challenging to use or didn’t protect the user’s data, they found three free apps that are worth a try (listed in no specific order): Medisafe, CareZone, and Round Health. Consumer Reports recommends ensuring any app designed for health information be HIPAA-compliant. To help combat the questionable privacy standards around mobile health apps, the ONC announced a challenge in 2016 called the Privacy Policy Snapshot Challenge that encouraged developers, designers, privacy experts to develop an online-based Model Privacy Notice (MPN) generator:
“The MPN is a voluntary, openly available resource designed to help health technology developers who collect digital health data clearly convey information about their privacy and security policies to their users. Similar to a nutrition facts label, the MPN provides a snapshot of a product’s existing privacy practices, encouraging transparency and helping consumers make informed choices when selecting products.”
The winners of the challenge were announced this past June.
Additional research on the effectiveness of medication adherence apps is needed to determine if they can have a positive long-term consequences for users. High-quality systematic testing of medication adherence apps is also needed to determine if they are helpful or harmful to patients.
Catherine Gupta
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