Study: Apps may help med adherence, even for technologically uninitiated seniors

By Jonah Comstock

ALICE med adherenceA randomized control trial of 99 elderly, Spanish patients suggests that a tablet app can improve medication adherence, even in patients with no prior experience with the internet, smartphones, or tablets. The study was published recently in the Journal of Medical Internet Research.

"With the growth in use of tablets and smartphones, various interventions have been designed to improve adherence and it has been found that such tools are effective and help to increase patient independence," study authors José Joaquín Mira PhD and Isabel Novarro (among others) from Miguel Hernández University, Elche, Spain wrote. "However, these apps have various limitations: they are conceived for patients familiar with these technologies, they have not been written for elderly patients (assuming that they would not benefit from this type of tool), and in most cases, patients have not been consulted about the design."

In the study, a tablet app for Android and iOS was designed with input and usability testing from three physicians, four pharmacists, and 23 patients. The app, called ALICE, had three functions: a space for storing information about prescriptions, instructions from a physician, and pictures of the drugs; a system of alerts and reminders; and a monitoring feature wherein the patient would indicate having taken medication and that information would be transmitted to a caregiver. The app was given to an experiment group of 51 patients; a control group of 48 did not use it. 

The study had modest but favorable results. Self-reported treatment adherence, measured on the Morisky Medication Adherence Scale, increased by 28.3 percent between the two groups and the rate of missed doses was 27.3 percent lower. Generally, the app did not help to lower medication errors, where patients took the wrong drug or dose, nor did it show a significant effect on health outcomes like hemoglobin or blood pressure. The experimenters hypothesized that the app was helpful in reminding patients to take their drugs and reminding them whether they already had.

Perhaps most interestingly, the 55 percent of the experiment group who had never used a computer, tablet, or smartphone, actually had slightly better adherence scores than those who were more familiar with technology. The app was also popular among the experiment group: Thirty of the 51 said that the ALICE app improved their medication use, 15 felt it helped to a certain extent, and only six said it didn't help at all.

"Most apps have been designed for patients with less complex health problems and/or experience with ICTs," the study authors conclude. "This study should change the expectations of developers and mobile phone companies, encouraging them to develop apps and devices suited to older patients with multimorbidity who are normally excluded from studies thought to be too complex, because such tools could improve the capacity of these individuals to manage their illnesses."