Do Medication Management Apps Increase Compliance
J Med Internet Res. 2022 Jun; 21(six): e12505.
Mobile Apps for Increasing Handling Adherence: Systematic Review
Monitoring Editor: Carlos Luis Parra-Calderón
Virtudes Pérez-Jover, PhD,# 1 Marina Sala-González, BSc,# 1 Mercedes Guilabert, PhD, 
# 1 and José Joaquín Mira, PhD# 1
1 Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
Mercedes Guilabert, Departamento Psicología de la Salud, Universidad Miguel Hernández, Altamira Edifice, Avda de la Universidad s/n, Elche, 03202, Spain, Phone: 34 966658600 ext 8984, Fax: 34 966658984, Email: se.hmu@trebaliugm.
Virtudes Pérez-Jover
1 Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
Marina Sala-González
1 Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
Mercedes Guilabert
1 Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Kingdom of spain
José Joaquín Mira
1 Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
Received 2022 October 15; Revisions requested 2022 Jan 26; Revised 2022 Mar 28; Accepted 2022 May 11.
- Supplementary Materials
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Multimedia Appendix 1.
Levels of evidence and degrees of recommendation.
GUID: B44AAD29-FD35-47E6-A2F3-10CE24999185
Multimedia Appendix two.
Assessment of the internal quality of the design of the studies.
GUID: E5873077-9586-4CA7-A71C-729B15530BFD
Abstruse
Background
It is estimated that 20% to 50% of patients practice not have their medication correctly, and this leads to increased morbidity and inefficacy of therapeutic approaches. Fostering treatment adherence is a priority objective for all health systems. The growth of mobile apps to facilitate therapeutic adherence has significantly increased in contempo years. All the same, the effectiveness of the apps for this purpose has not been evaluated.
Objective
This written report aimed to analyze whether mobile apps are perceived every bit useful for managing medication at home and if they really contribute to increasing treatment adherence in patients.
Methods
Nosotros carried out a systematic review of research published using Scopus, Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information well-nigh their contribution to increasing therapeutic adherence and the perceived usefulness of mobile apps. This review examined studies published between 2000 and 2022.
Results
Overall, eleven studies fulfilled the inclusion criteria. The sample sizes of these studies varied between 16 and 99 participants. In addition, 7 studies confirmed that the mobile app increased treatment adherence. In five of them, the earlier and later on adherence measures suggested meaning statistical improvements, when comparison self-reported adherence and missed dose with a pct increase ranging between 7% and 40%. The users found mobile apps easy to use and useful for managing their medication. The patients were generally satisfied with their use, with an average score of eight.one out of 10.
Conclusions
The use of mobile apps helps increase treatment adherence, and they are an appropriate method for managing medication at home.
Keywords: mobile wellness, medication alarm systems, medication adherence
Introduction
Background
The World Health Organization has classified the lack of treatment adherence as a major global problem [1]. This is partly considering of therapeutic nonadherence being associated with high health costs because of rehospitalizations equally a consequence of the lack of therapeutic response, changes in prescriptions for other more strong and toxic medications that increment the risk of producing side effects or long-term medication dependence, and, above all, the decreased efficacy from medication that patients either do non take or have inappropriately [2,three]. These consequences lead to increased morbidity and mortality in nonadherent patients [ii,4].
Figures for Therapeutic Nonadherence
It is estimated that twenty% to fifty% of patients practice non take their medication correctly [5-7]. The reasons for this lack of adherence to treatments are varied. On the one hand, patients may voluntarily stop taking their medication considering of, for case, a perception of the lack of improvements, beliefs that they have not been diagnosed correctly, or the agin effects of the drug. However, the most frequent reasons for therapeutic nonadherence are involuntary causes, such as confusion or simple forgetfulness [2,five,8,9]. Medication errors at home are more usual than expected by health intendance professionals [8,ten,eleven]. This would seem to indicate that designing and applying methods that foster treatment adherence and contribute to reduce medication errors at dwelling are necessary.
Pillbox
The almost commonly used device to promote medication adherence is the pillbox. People tin can independently manage their medications, bank check whether they take taken them or not, avoid the risk of taking them twice or not taking them at all, and reduce the rate of medication errors. Previous studies found that people who used a pillbox had better treatment adherence [12-xiv]. There are Medication Event Monitoring Systems (MEMSs), whose popular name is electronic pillbox. They take the additional characteristic of reminding patients to take the medication with alarms, and they are considered as the gold standard for measuring adherence [fifteen]. However, unfortunately, none of these pillboxes are exempt from problems. They are also big to become them out of the business firm. In addition, patients have to understand the prescribed therapeutic regimen to organize the medication in the compartments and know how to manage these pillboxes [12-17].
Smartphones and Health Apps
All the research indicates that new data technologies have been rapidly accustomed by the unabridged population [18]. In the case of Spain, 94.6% of its population currently uses a mobile phone [19].
This blast in mobile phones has resulted in these devices being used to devise new procedures to promote therapeutic adherence. At first, curt bulletin service (SMS) text messages were sent and telephone calls were made to remind users of the need to accept medication. These kinds of reminders have been very effective methods and are well accepted by patients [20-22].
Then, with the appearance of smartphones came mobile apps that accept likewise afforded new opportunities for carrying out deportment that simplify daily tasks, amidst them caring for health [half-dozen,8,18,23-25]. Currently, there are more than 165,000 apps designed for these devices that are related to wellness, and one in 5 people take downloaded a mobile health (mHealth) app [xviii]. Among these apps are a growing number intended to assist patients in the management of their affliction and their medication, remind users to take their drugs, and provide them with information nigh how they should do it to promote handling adherence. These mobile apps are not merely intended to help people remember to take the medication, such as the electronic pillbox; they have additional useful features that non only promote medication adherence but besides increase treatment adherence.
Even so, very little inquiry has been undertaken to evaluate the effectiveness of these apps for the purposes for which they were intended or the level of acceptance among users [vi,xviii,26]. In that location are too no studies about their contribution to safe medication use.
Objective of This Study
This study aimed to analyze whether mobile apps that help people manage their medication in the habitation contribute to increasing patient adherence and are considered useful by the users.
Methods
A systematic review study that applied the recommendations in the Preferred Reporting Items for Systematic reviews and Meta-Analysis annunciation for these types of studies was carried out [27].
Concepts to Be Taken Into Business relationship in This Review
Pillbox
A small container that pills are carried in. A pillbox can brand the medication task easier because it helps people to manage their daily medication. This device is associated with improvements in medication adherence and, afterwards, with better wellness [12].
Electronic Pillbox
The MEMS is a pill organizer that has the additional feature of reminding you lot to take your drugs with visual and audio alerts. This MEMS provides information about treatment adherence. Therefore, it is the gold standard for this purpose [17].
Mobile Apps
Mobile apps are estimator programs or software installed on mobile electronic devices that supports a wide range of functions and uses, including goggle box, telephone, video, music, word processing, and internet services [16].
Mobile Apps to Amend Medication Adherence
In this written report, we considered the kind of mobile apps that help people to manage their medication. These mobile apps, compared with pillboxes or electronic pillboxes, have the main reward of beingness a arrangement that is incorporated into our smartphones [16].
Selection of Studies
The inclusion criteria for this review included research published in either English or Spanish that provided results nigh the effectiveness or treatment adherence in using mobile apps in the management of medication in the home, with whatever historic period group as the study population and regardless of the pathology and prescribed medication. Both quantitative and qualitative inquiry were included, likewise as inquiry with descriptive and experimental approaches. The studies included in this review included presentations of results most the effectiveness in fostering adherence to treatment, safe medication utilise, viability, acceptance, satisfaction, and usefulness of these mobile apps. Nosotros excluded studies that were merely descriptive about the design of the mobile apps without presenting the results of use feel. We also excluded studies in which the interventions to remind patients to have their medication were delivered via SMS text messaging, phone calls, or electronic pillboxes.
Search Strategy
We carried out a search for scientific documentation in the Scopus, Cochrane Library, ProQuest, and MEDLINE databases using keywords associated with pillbox and mobile apps and using the Boolean indicators OR and AND (pillbox OR pill reminder OR pill organizer OR pill dispenser OR medication organizer OR medication reminder OR medication systems OR medicine reminder OR reminder arrangement AND mhealth OR mobile app OR mobile awarding). The search for documents was limited to publications that appeared in scientific journals from Jan 2000 through January 2022. The same descriptors were used to search the internet for relevant greyness literature using the Google search engine. We similarly undertook a transmission search using the bibliographic references of the selected publications.
The initial search identified 212 papers, of which 32 were eliminated because of being duplicates. Similarly, nosotros found an additional 8 studies within either the bibliographies of the articles selected or through a Google search. Nosotros analyzed the titles and abstracts and eliminated 188 papers because they did not fulfill the inclusion criteria. Nosotros and so fully read the 23 remaining papers and discarded 10 of them considering they did non evaluate the effectiveness of the mobile app. Ultimately, 11 papers fulfilled the inclusion criteria (Figure 1).
Catamenia diagram of the study inclusion and exclusion process.
Data Extraction
The data extracted for each study included its country, objective, participants, chronic condition, design, and duration. Moreover, nosotros recorded the functions of each mobile app, names of its designer(s), measures for evaluating adherence, measures for evaluating the mobile app, and outcomes of its evaluation.
In addition, to evaluate the quality of the reviewed publications, we first analyzed the level and degree of evidence following the classification proposed by the Scottish Intercollegiate Guidelines Network [28]. Then, we assessed the post-obit criteria (with a dichotomous yep/no calibration): if it was reflected in the study that patients had participated to some degree in the app design, if the sample error had been controlled by adjusting the size of the sample under written report, if there had been randomization with the samples who participated in the report to decide the app effectiveness, if validated measuring scales had been used, and whether the app had been used nether natural atmospheric condition for periods of time exceeding 3 months.
We classified the levels of show as follows: 1++ (meta-analyses, systematic reviews of clinical trials, or high-quality clinical trials with very little risk of bias), 1+ (meta-analyses, systematic reviews of clinical trials, or well-conducted clinical trials with little risk of bias), one− (meta-analyses, systematic reviews of clinical trials, or clinical trials with loftier take chances of bias), 2++ (systematic reviews of accomplice or instance-control studies or studies of loftier-quality diagnostic tests and accomplice or case-control studies of high-quality diagnostic tests with very little risk of bias and a high probability of establishing a causal relationship), 2+ (cohort or example-control studies or studies of well-conducted diagnostic tests with a low risk of bias and a moderate probability of establishing a causal relationship), 2− (cohort or case-command studies with a high risk of bias), 3 (nonanalytical studies, such as example reports and instance serial), and four (expert opinions) [28].
We classified the strengths of the recommendations as (A) at to the lowest degree 1 meta-assay or systematic review of a controlled and randomized trial (CRT) or a level 1++ CRT, directly applicable to the target population or sufficient bear witness extrapolated from ane+ level studies, directly applicable to the target population and whose results demonstrate overall consistency; (B) sufficient bear witness deriving from level 2++ studies, directly applicable to the target population and whose results demonstrate overall consistency, with evidence extrapolated from either 1++ or i+ level studies; (C) sufficient evidence deriving from level two+ studies, directly applicable to the target population and whose results demonstrate overall consistency, with show extrapolated from level 2++ studies; and (D) testify from either level three or 4 studies, with show extrapolated from level 2+ studies [28].
The evaluation and classification of the studies plant during the search strategy were completed independently past 2 investigators (MS and VPJ). Discordant elements were discussed by both investigators until an agreement was reached.
Results
The initial search identified 212 papers. Ultimately, 11 papers fulfilled the inclusion criteria (Effigy ane). Multimedia Appendix ane shows the level of evidence and the degrees of recommendation of each of the 11 selected studies. Multimedia Appendix 2 shows the assessment of the internal quality of the design of each study.
Study Objectives
In seven of the 11 studies [9,18,24,29-32] analyzed, a mobile app was designed and evaluated, whereas 4 studies [23,33-35] evaluated a previously designed app. Furthermore, 7 studies [nine,23,29-31,33,35] evaluated both the perceived usefulness and treatment adherence when using a mobile app. In addition, 4 studies assessed perceived usefulness but did not evaluate adherence [18,24,32,35].
Moreover, 1 written report [34], in addition to evaluating the mobile app's viability and acceptance, compared the intervention of iv groups: mobile app with a reminder, mobile app without a reminder, electronic pillbox with a reminder, and electronic pillbox without a reminder. The objective of some other written report [18] was to evaluate the advertisement hoc–designed mobile app and compare the responses between people both older and younger than 55 years. However some other report [35] compared the ease of use and usefulness of various mobile apps found for managing medication.
Description of the Population in the Reviewed Studies Using These Mobile Apps
The sample sizes varied between 16 and 99 participants [nine,24]. The participants' ages varied depending upon the study. Of the studies, 2 focused on adolescents [24,29], i was directed at persons over the historic period of 65 years [9], some other 1 was for persons over the age of lx years [31], and another ane for persons over the age of 50 years [35]. In add-on, ane study included adults with a wide age range (from 45-ninety years) [34] and some other compared the responses between people older and younger than 50 years [18].
The investigators recruited the samples at hospitals [23,24,29,30,33], health centers [ix,32], patient associations [23,32,34], and local cardiac rehabilitation sports groups in a university [31] also equally with flyers and events at social centers and medical clinics [35].
Chronic Weather of the Patients Included in the Studies of Mobile App Use
The apps used in this study included different weather condition, such every bit asthma [29], eye failure [31,34], hypertension [30,33], and HIV [23,33]. The remaining apps did non focus on a specific illness [9,xviii,24,32,35]; notwithstanding, the inclusion criteria for 2 of these studies included people suffering from multiple pathologies [9,32,33], and in another of the analyzed studies, the patients had to exist recipients of solid organ transplants [24].
Designs Employed in the Studies
To compare results, 4 studies carried out randomized controlled trials [9,23,31,34]. The first of these compared treatment adherence in 2 groups: those who used the mobile app (experimental group) and those who did not (command grouping) [9]. The second study that conducted a randomized controlled trial compared treatment adherence between a command grouping that employed a mobile app with an experimental grouping that used an extended version of that same app [23]. The third randomized controlled report compared the interventions of 2 groups, mobile app and electronic pillbox, and under 2 conditions each: mobile app with a reminder, mobile app without a reminder, electronic pillbox with a reminder, and electronic pillbox without a reminder [34]. Finally, the fourth study compared the employ of the app versus a paper diary [31].
Furthermore, two studies compared ii independent samples. One of these compared the responses of persons older and younger than 55 years as its objective was to verify the differences between the effectiveness and ease of use of the app between these ii groups [eighteen]. Another compared the effectiveness of various mobile apps [35].
The remaining 5 studies [24,29,30,32,33] described assessment of the mobile apps by the patients
Time of Employ of the Mobile Apps
The time that the participants used the mobile apps varied between 2 hours and 6 months, depending upon the study [33,35].
A description of these issues is in Table 1.
Tabular array one
Details of the included studies.
| Authors and state | Objective | Participants | Chronic condition | Blueprint (Duration) |
| Anglada-Martínez et al, Spain [33] | Evaluate i Web and smartphone-based medication self-direction platform, named MedPlan. | N=42; average age: 56 years | Hypertension "and" or "or" dyslipidemia and HIV | Transversal (half dozen months) |
| Burbank et al, United States [29] | Examine the viability of a mobile application for adolescents with asthma. | N=20; adolescents; boilerplate age: 13.5 years | Asthma | Transversal (viii weeks) |
| Fallah and Yasini, France [eighteen] | Design and evaluate a mobile medication reminder app. | N=60; <55 years: North=thirty; and >55 years: N=30 | —a | Transversal (—) |
| Goldstein et al, United States [34] | Compare the adherence of two interventions, electronic pillbox and mobile apps, under experimental conditions with and without medication reminders, in addition to evaluating the viability and effectiveness of each. | North=58; elderly adults; average historic period: 69 years | Heart failure | Randomized controlled (28 days) |
| Grindrod et al, Canada [35] | Explore the ease of use and usefulness of existing mobile apps for handing medication in elderly adults. | N=35; >50 years; average age: 67 years | — | Transversal (two hours) |
| Kang and Park, South korea [30] | Develop a mobile application for managing hypertension and evaluate its usefulness, user satisfaction and adherence to medication. | N=38; average age: 56 years | Hypertension | Transversal (4 weeks) |
| Mertens et al, Germany [31] | Analyze if mobile awarding to support the therapy direction will be accustomed by elderly patients with chronic conditions and would improve their therapy adherence. | N=24; boilerplate age: 73.eight years | Coronary eye disease or myocardial infarction | Randomized controlled (84 days) |
| Mira et al, Espana [32] | Design, develop, and evaluate a mobile app that enables safer use of medication in elderly patients who have multiple medications. | North=61; elderly adults; average age: 68.8 years | Pluripathology | Transversal (—) |
| Mira et al, Espana [nine] | Design, implement and evaluate a mobile app for cocky-management of medication in elderly patients who have multiple medications. | N=99; >65 years; experimental group: N=51; and command group: N=48 | Pluripathology | Randomized controlled (three months) |
| Perera et al, New Zealand [23] | Examine the effectiveness of a mobile application for facilitating treatment adherence to combined antiretroviral therapy. | N=28; average historic period: 46; experimental group: N=17; and command group: N=xi | HIV | Randomized controlled (3 months) |
| Shellmer et al, The states [24] | Design a mobile awarding for improving treatment adherence in adolescent recipients of solid organ transplants and evaluate its credence, ease of utilize and satisfaction. | N=7; adolescents; + nine caregivers | Recipients of solid organ transplants | Transversal (6 weeks) |
Functions of the Mobile Apps
The contents of the mobile apps included reminders for taking medication; some of these studies did and so with alarms (visual and audio) that the patients had previously recorded [9,18,24,29-31,33]. When the alarm sounded, they had to confirm that they had taken the medication [ix,23,24,29,31,33], and the apps notified their caregivers when the users failed to betoken that they had indeed taken the medication [ix,24]. The apps provided instructions on how to accept the medication [9,eighteen,24,31-33], general data about the treatments and medication [18,30-33], education about the disease [24,29], and recommendations on healthy habits [9,30].
Some more specific functions of each app included reminders with alarms for doctors' appointments [xxx], claret pressure level records [thirty], or their symptoms in general [29] and images of the medications taken to distinguish them when the fourth dimension came for them to be taken, thus increasing patient prophylactic [9,31,33]. The TUMEDICINA app (APPANDABOUT, SL) enabled scanning of the bar codes on medication containers to gain information about the intended therapeutic objectives, verbal instructions on how and when to take them, interactions with other medications, expiration dates, and storage indications. All this information was stored as audio recordings [32]. The app for HIV patients independent a 24-hour medication clock for the control and experimental groups. The latter used an extended version of the app that additionally included personalized images about the level of medication and the level of immunoprotection inside the patient's body [23]. The Teen Pocket PATH app had one version for caregivers and some other for patients and included general information such every bit telephone help numbers [24].
Profile of Mobile Apps Design Participants
In half-dozen of the studies, the pattern of the app was fabricated from patient information compiled with qualitative techniques, such as in nominal groups [9,xviii,24,29,30,32]. In addition, wellness professionals participated in the app design in 3 of them [9,18,29], and technology specialists also participated in i [19]. In another written report, in addition to including participation from the patients who were subsequently going to use the app, the blueprint besides kept their caregivers in listen [24]. In some other report, the app was designed exclusively by technology experts [thirty].
Mobile App Availability
In 5 of the eleven studies, the mobile apps were available in both Android and iOS versions [9,29,32,34,35], whereas 4 were merely bachelor for Android [18,23,24,30,33] and 2 were only bachelor for iOS [31]. Furthermore, among the studies, 1 study compared mobile apps of Android and iOS environments [35]. In 3 studies, the participants downloaded the app on their mobile phones [23,29,30] and in four studies, the users were offered either iPads or tablets with the downloaded app [9,24,31,35].
Reference Measures for Evaluating Treatment Adherence
The questionnaires administered for evaluating treatment adherence were the Modified Morisky Scale [xxx]; the Morisky Medication Adherence Scale along with a questionnaire for evaluating the rates of lost doses and medication errors [9]; Medication Adherence Written report Scale [23]; Simplified Medication Adherence Questionnaire [33]; the subjective adherence mensurate A14 calibration [31]; the Asthma Control Examination for evaluating the impact of asthma on daily functions, frequency of shortness of breath, frequency of asthmatic symptoms at night, frequency of using rescue medicines, and general control of asthma; and the Child Asthma Self-Efficacy for determining the prevention and management of asthma attacks [29]. The other methods used included chemist's dispensers, measuring the quantity of virus in the claret plasma of each HIV patient [23], and dividing the number of medications that were marked as having been taken by the number of medicines prescribed [34].
Quantitative Measures for Evaluating Mobile App Functions
The questions used for evaluating the mobile apps included the Post Study System Usability Questionnaire [24] and the System Usability Calibration, which adamant the employ of the app [35]. I study administered a questionnaire to evaluate the app's effectiveness and ease of use in which the questions for evaluating the ease were extracted from the Arrangement Usability Scale [18]; 1 written report created a questionnaire to evaluate the credence, usefulness, satisfaction, willingness to recommend the app to other persons, and the opinion the users held about it [34]; and 1 study evaluated the usefulness by using the questionnaire on perceived usefulness by Davis and the satisfaction by ways of a questionnaire that evaluated satisfaction with each of the app'south contents [30]. Another study evaluated the use of the app according to the number of times that each participant examined each of the contents in the app and the amount of time invested in each content. Furthermore, a questionnaire was administered with questions about the app's satisfaction, perceived utility, ease of use, visual appeal, and discretion and well-nigh the information it provided [23]. In another written report, a questionnaire was administered that evaluated the app'southward characteristics and operation [32]. Finally, 1 report assessed usability and satisfaction through self-reported questionnaires [33].
Qualitative Measures for Evaluating Mobile App Functions
Overall, vii studies compiled patient data using qualitative techniques wherein questions were asked almost the satisfaction, usefulness, ease of apply, acceptance and the contents of the apps [9,24,29,31,32,35].
Mobile App Effectiveness in Treatment Adherence
Furthermore, 7 studies confirmed that the mobile app increased treatment adherence [9,23,29-31,33,34], and in 5 of them, the differences in adherence before and later the study were statistically significant [9,23,30,31,33]. The study that compared the intervention of the mobile app with that of the electronic pillbox did not find significant differences between the type of device used or the reminders and treatment adherence; notwithstanding, the participants declared that they preferred the mobile device [34]. Another study did not find statistically significant differences in the control of asthma before and after the report, although the patients with uncontrolled asthma before the study did prove a significant increase in their scores. Mean scores on asthma cocky-efficacy before and subsequently the study increased but were non significant. Withal, in that location was a significant increment in preventing an asthma attack [29]. In addition, 3 studies establish that the mobile app reduced the occurrence of missed dose significantly [9,31,33]. In add-on, the device decreased medication mistakes simply in people who had reported committing 2 or more errors earlier the report [9].
Satisfaction With the Mobile Apps
The participants declared that that they were satisfied with the app in all 7 of the studies that included this mensurate [9,23,24,29,xxx,32,33]. They were more satisfied with the functions that helped them to promote treatment adherence such equally reminders and recording symptoms and medication information [thirty,35]. People who rated the highest were those who organized their medication in pillboxes, took notes on medication containers, and took less than six every day [32]. Moreover, experimental groups who used mobile apps were more than satisfied compared with command groups with other devices [23,34].
Other Evaluated Elements
Ease of employ was estimated in 6 studies [9,xviii,23,24,32,35], and in 4 of them, the participants stated that the app was easy to apply [9,xviii,24,32]. Furthermore, 1 study confirmed that in that location were no statistically significant differences in the ease of utilize between those younger and older than 50 years [18], whereas some other found no statistically significant differences between persons who used mobile phones or browsed the net with those who did non [32]. In 1 study that compared various apps, only 1 of the apps received scores for ease of use that were lower than the remaining apps. Moreover, people rated the experience of using the mobile apps every bit hard, although that changed when they learned how to utilize them [35].
In v studies, the participants stated that these mobile apps were useful [23,24,30,32,34]. In addition, in 1 study, the participants suggested that the app would be even more useful if information technology added the option of an alarm equally a reminder for taking medication [23]. Yet another study demonstrated that the ideal app would be one that helped foster treatment adherence and, furthermore, provided information well-nigh the illness and its treatment [35].
Finally, 1 study [23] that compared a reduced version of an app (command grouping) with an extended version (experimental group) found that the participants from the experimental group rated their app as more informative, more visually appealing, and more than of a motivator for promoting adherence to treatment in comparison with the control group, and nearly all the participants would recommend the mobile app to their friends.
A description of these bug is in Table ii.
Table two
Details of the apps used in the included studies.
| Study | App functions and blueprint | Medication adherence measure | Measure for evaluating app | App evaluation |
| Anglada-Martínez et al [33] | MEDPLAN. Drugs information, medication reminder alarm system, where patients ostend whether they have taken the drug or non. App designed by wellness professionals. | Simplified Medication Adherence Questionnaire (SMAQ), pharmacy refill method and number of days with missing dose. | Usability and satisfaction assessed through self-reported questionnaires. | When adherence was measured using the SMAQ, handling adherence improved during the intervention phase (19.4%; P<.05), and the number of days with missed doses decreased (P<.05). The mean satisfaction score for Medplan was 7.2 ± two.7 out of maximum of 10 points. 71.iv% of participants said they would recommend the App to a friend, and 88.ane% wanted to go along using it. They thought the application could be more useful in patients on polypharmacy, at the first of a treatment, for caregivers or for the elderly population. |
| Burbank et al [29] | Medication reminder, reminder for recording symptoms, feedback on its adherence and pedagogy nearly asthma. The App was designed by patients and health professionals. | Asthma Control Test. Kid Asthma Self-Efficacy Questionnaire. | Questions about satisfaction. | In spite of the improvement in the control of asthma earlier and after the study, in that location were no significant differences (P=.53). Nevertheless, the scores improved significantly for those who did not control asthma earlier the intervention (P=.03). Mean scores on self-efficacy before and after the written report increased, but were non pregnant (P=.13). Although there were significant differences in preventing an asthma attack (P=.04). Satisfaction: 93% |
| Fallah and Yasini [18] | Reminders via alarms, instructions and information almost medication. The App was designed by patients, health professionals, and engineering specialists. | —a | Questionnaire for evaluating the application's effectiveness and ease of use. The questions for evaluating its ease of employ were taken from the System Usability Calibration adapted for mobile applications. | No significant differences were institute between the effectiveness or ease of use in either historic period group (greater and younger than 50). Both groups found the app effective and easy to employ. |
| Goldstein et al [34] | — | Electronic pillbox: opening the pillboxes. Mobile awarding: electronic cocky-reports. The number of medications taken was divided by the number of medications prescribed. | Questionnaire for evaluating the acceptance, usefulness, satisfaction, willingness to recommend information technology and their opinion about the device. | Improves treatment adherence with both interventions (80%). No pregnant differences were plant betwixt the type of device and adherence (P=.87), neither were at that place between the condition and adherence (P=.48). Those in the mobile awarding group awarded higher scores on credence and usefulness of their device (P<.001). All participants preferred the intervention of the mobile awarding. |
| Grindrod, Li and Gates [35] | — | — | System Usability Scale. Questions in a group session: ease of use, user experiences, expected adoption, concerns about the potential for information entry errors, perceived quality of the provided data and preferences for the different characteristics. | The Pocket Chemist awarding received an ease of use score that was significantly lower when compared to the remaining applications (P<.001). They initially rated the experience of using the applications every bit frustrating, although that inverse when they learned how to utilise them. They would use these applications if they someday needed to due to cognitive or health bug. The ideal application would possess characteristics that helped foster adherence and provide information. |
| Kang and Park [30] | HYPERTENSION Direction APP. Reminders with alarms for taking medication and doctor'south appointments, recording blood pressure, recommendations nigh lifestyle and data on medication. The App was designed by patients and experts. | Modified Morisky Scale. | Questionnaire with a calibration from 1 to 5 that evaluated perceived usefulness and satisfaction with each of the awarding'due south contents. | The average scores on adherence increased significantly earlier and after the study from four.2 to 5.2 out of a maximum of six points (P=.001). Perceived usefulness: 3.vii. Satisfaction: 3.viii for medication reminders, 3.2 for alarms, 4.three for recording blood force per unit area, 3.1 for the information sent, 3.4 for recommendations, and three.eight for pedagogy about medication. |
| Mertens et al [31] | MEDICATION PLAN. Reminders via alarms, instructions and data about medication. The App was designed past health professionals. | Subjective adherence was adamant by the A14-scale. Objective adherence was measured by number of medications each participant had to accept each twenty-four hour period. | Semistructured interviews. | The hateful for subjectively assessed adherence in that location was a pregnant increase after the interventional phase from 50 to 54 out of a maximum of 56 points (P<.001). The app showed pregnant adherence for medication intake (P=.03). The bulk of participants (due north=22) stated that they would like to use the medication app in their daily lives. |
| Mira et al [32] | TUMEDICINA. Scans the bar codes on the medication box to provide information about its therapeutic objective, indications for taking information technology, interactions with other medications and its date of expiration. This information is stored as audio recordings. The App was designed by patients. | — | Group session and individual questionnaire for evaluating the characteristics and operation of the awarding. | The characteristics rated highest were the simplicity and clarity of the exact messages (96.7%), the usefulness of the verbal letters (93.4%) and the clarity of the data provided (95.1%). No significant differences were institute in the assessment of the satisfaction between patients with or without experience of using mobile telephones or browsing the Internet (P=.88). The people who rated the application the highest were persons who organized their medication in pillboxes, took notes on medication containers and took less than six drugs every day. Satisfaction: 8.3 out of ten. |
| Mira et al [9] | ALICE. Reminders with alarms for taking medication and carrying out healthy habits, images of drugs, instructions on how to take medication, SMS sent to caregivers in cases where the medication is not taken. The App was designed past patients, health professionals, and technology specialists. | Morisky Medication Adherence Scale. Questionnaire for evaluating rates of missed doses and medication errors. | Questions for evaluating the application: satisfaction, ease of utilize, performance, usefulness, reliability, acceptance, pattern, simplicity, accessibility, if they would recommend it and if it afforded them independence. | Treatment adherence improved in the experimental group (28%; P<.001) and in a lower rate of omitted doses (27.3%; P=.02). The application was non effective in reducing the charge per unit of medication errors, it only decreased in patients who had reported committing 2 or more errors before the report (41.2%). Satisfaction: 8.5 out of 10. Persons without experience of data technologies said that using the application was not complicated. |
| Perera et al [23] | The awarding used past the control grouping independent a 24-hour medication lookout. For the experimental grouping, in add-on to the lookout man, information technology contained personalized messages about the levels of medication and immunoprotection in the patient's body. | Medication Adherence Report Scale. Pharmacy prescriptions filled. HIV viral load. | Questionnaire for evaluating the satisfaction, perceived usefulness, ease of use, visual appeal, discretion and provision of information. | Greater treatment adherence in the experimental group according to the scores on the Medication Adherence Study Calibration (40%; P=.03) and co-ordinate to the viral load HIV (19%; P=.02). However, in that location were no significant differences in the chemist's dispensing data (P=.xviii). The experimental group participants were more satisfied with the application than the control group and they rated it as informative, attractive and motivating. 79% said that adding the selection of an warning to remind about taking medication would be useful. 81% of the experimental group would recommend the application. |
| Shellmer et al [24] | TEEN POCKET PATH. Reminder of what medication must exist taken and in what dose, confirmation that it had been taken, information most the type of transplant received and full general information, such as phone help lines. Caregivers received information as to whether the adolescents had taken their medication. The App was designed by patients and caregivers. | — | Post Study Organisation Usability Questionnaire. Questions during one session: ease of utilise, viability, satisfaction, usefulness, simplicity of the reminder, alert messages sent to the caregivers and perceptions near long-term use of the application. | Users and caregivers found the awarding easy to utilize, effective, useful and they were satisfied with it. The caregivers said that they felt less need to constantly ask the adolescents about whether or not they had taken their medication. |
Discussion
Primary Findings
These results indicate that mobile apps help promote treatment adherence [ix,23,29,thirty,34]. However, when considering the sample size and time of use of the mobile apps under natural conditions, new studies with longer use times than the apps merit consideration to discover out whether an adaptation upshot exists that has a negative outcome upon adherence, for instance, after more than than 12 or eighteen months of using these apps [21,22,25].
I matter to go on in mind is that these studies focused exclusively on the lack of adherence caused involuntarily past the patient. They did not control participant variables of the locus control type or confidence or human relationship with wellness professionals. Users of these apps who voluntarily and consciously rule out following the treatment can use these devices to gain greater credibility with their caregivers or health professionals by indicating in the app that their medication has been taken even when this is not the case. This is the same problem with traditional pillboxes and in research on therapeutic adherence [eight].
The gold standard used for determining therapeutic effectives has been based on the apply of reports by patients obtained using validated scales and widely used in inquiry on adherence [9,23,29,30]. Only 1 study used a more objective and reliable mensurate of adherence, that of blood determinations [23].
The bulk of patients stated that the mobile apps they had used were easy to apply [9,18,24,32] and useful [23,24,thirty,32,34] and that, additionally, they were satisfied with their ease of use, navigation, and features [9,23,24,29,30,32]. The studies analyzed show that persons anile over 60 years practice non encounter difficulties when using these apps and that, therefore, there are no barriers considering of historic period [9,18,32]. In these cases, it should be pointed out that the apps had been designed with the intrinsic characteristics of the target population in mind, such as letter or image sizes [9,18,32]. In add-on, it is important to consider that personal characteristics, such as computer literacy, health literacy, mental health status, and cultural background, are related with the use of mHealth apps [36].
It should be noted that in most of the studies, the mobile apps were designed especially for future users [9,18,24,29,xxx,32]. This indicates that the app design is made according to the needs of patients and has probably contributed not just to their effectiveness but also, above all, to satisfaction with the app.
The main contents in the apps to foster treatment adherence were reminders with alarms for taking the medication [9,18,30], data virtually the medication [18,30,32], and medication-tracking histories [9,23,25,29].
Although the level of cognition about the illnesses or their treatments was not controlled in the studies carried out, one could expect that using these apps contributes to greater cognition about the disease and the drugs that are taken every 24-hour interval. In some cases, these apps include information most drug storage and most potential (the near frequent) drug interactions with other active ingredients or natural products [18,30,32]. This is a relevant aspect considering the studies point out that the noesis patients possess about their medication could be improved, and it should exist an objective when these types of apps are designed. Education about handling is particularly important for those who commit more errors in its administration, such equally those who use devices such equally glucometers or inhalers, and for caregivers of minors [7,eight].
Other app functions to promote adhering to the therapeutic regimen were reminders almost leading a healthy lifestyle [nine,thirty] or reminders almost keeping appointments with physicians [30]. These functions, positively valued by patients, provide added value compared with traditional pillboxes.
This review shows that mobile apps are effective in promoting handling adherence and that they contribute to patient rubber by avoiding errors in the administration of their treatments. Owing to this, health professionals, such every bit physicians or pharmacists [37], should promote their utilise by recommending that their patients download them and then monitor how these apps are used, considering simply downloading them does not ensure their total use [8,9].
Limitations
Amongst the possible limitations of this study, information technology should be mentioned that despite having carried out the search in the most important databases on medicine, it is probable that other databases were not considered. In improver, although we used a wide range of descriptors to obtain a more than precise strategy, there might be a specific keyword from a concrete area that was non controlled.
Furthermore, we did non include articles in languages other than English and Spanish nor did we consider abstracts from conferences.
Another limitation to highlight is the difficulty in compiling the results considering of the wide heterogeneity of methodologies and results from the articles that were found.
This study evaluates the effectiveness of mobile apps as a method for overcoming errors by patients in managing medication. However, these mobile apps do non offer alternatives for controlling voluntary nonadherence by patients.
Comparison With Other Studies
We know that i in v elderly patients forget to take their medication or make mistakes when doing so [38]. The use of new technologies is a relevant method for overcoming the problems of lack of adherence to treatments, which results in harmful consequences for the health of patients and for those who are elderly. The effectiveness of the mobile apps could be because of the furnishings that alarms accept on forgetfulness, as this is ane of the chief contributors to the lack of treatment adherence [25], but these apps must also be employed with patient rubber in mind, for example, with data on how to avoid drug interactions, with data on how to properly store the medication, or with instructions on which foods the medication tin and cannot exist taken with.
Most of the studies focused on specific diseases, just all of them had a mutual arroyo toward chronic diseases [9,23,24,29,30,32,34]. Previous enquiry establish that lack of treatment adherence is more than frequent in persons with chronic diseases because of the complexity of therapeutic regimens, regardless of historic period [5,9,32,36]. For this reason, solutions to lack of treatment adherence caused involuntarily past the patient must be personalized past considering the patient's profile and the posology, which have a more direct touch on the difficulties of taking medication.
The relevance of using smartphones to foster treatment adherence is as well because of their credence, ease of apply, and affordability [21,26]. These findings justify that elderly people, when the app has been designed with their needs in mind, are non a barrier as some of the reviewed studies suggest.
Park et al [21] found that positive and personalized feedback resulted in positive effects on medication adherence. This is the function that digital pillboxes perform. Personalizing alarms could contribute to their effectiveness and to that effectiveness lasting for longer periods.
Other studies take evaluated the effectiveness of other technological methods by which handling adherence can be enhanced, such every bit telephone calls or SMS [20,21,22]. Although these are simply equally effective, they involve high costs [20,26]. Furthermore, these interventions but accept into account reminders for taking the medication, whereas mobile apps provide more content, such as educational interventions [22].
In add-on to mobile apps found for fostering treatment adherence, in that location are besides apps for promoting adherence to other therapeutic regimens, with reminders for leading an appropriate lifestyle, reminders for keeping doctors' appointments, and monitoring other health data (eg, supplements and manage pets), among others [26,38]. The integration of these functions should exist considered when designing new apps for virtual pillboxes.
Hereafter Enquiry
From these results, recommendations for the design of future apps tin can also be deduced when because the contents valued highest by the patients. Park et al [37] take establish that features appreciated by users are app performance and applied aspects, helpful reminders and notifications, monitoring other health information, versatility of medication information input and display, and supporting health care visits [37]. Standing out among these are the flexible management of alarms that warn nigh taking medication and education about the type, utilise of, and precautions well-nigh the medication that they take [23,35]. Conversely, these functions have better value for the participants when they utilise elementary interfaces. For this reason, mobile apps are easy to use and people brand more use of them [35,39]. Furthermore, information technology should be emphasized that the future users of the apps must participate in their blueprint to focus on their necessities [9,18,24,29,35,39].
The bulk studies included in this review evaluated treatment adherence by validated scales such equally the Morisky Medication Adherence Scale [9,30]. Future studies should incorporate objective measures, for case, the most common measure is blood test [23].
In addition, patient prophylactic should be considered in these mobile apps considering these assistance them to manage their medication and they could make mistakes when taking their drugs [ix].
Finally, the studies with longer use times of the apps are considered necessary to integrate the mobile apps in their daily routine and examine their effectiveness for treatment adherence in the long term [17-nineteen,22].
Conclusions
Mobile apps prevent forgetting about medication and wrong administration and, thus, contribute to patient prophylactic. In the hereafter, these apps should include personalization of the personal weather condition and posology of the medication the patient takes.
Acknowledgments
This study was financed past the Conselleria de Educación, Generalitat Valenciana Excellence Groups Prometeo/2017/173.
Abbreviations
| CRT | controlled and randomized trial |
| mHealth | mobile health |
| MEMS | Medication Event Monitoring Organization |
| SMS | brusk message service |
Multimedia Appendix 1
Levels of bear witness and degrees of recommendation.
Multimedia Appendix 2
Assessment of the internal quality of the design of the studies.
Footnotes
Conflicts of Involvement: None declared.
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Do Medication Management Apps Increase Compliance,
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604503/
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