Background: Medication reminder apps have been proposed as potential tools to help reduce the global problem of medication non-adherence. However, there is a lack of evidence that these medication reminder apps are effective and it is unclear which app features influence user engagement.
Purpose: The primary aim of this study was to examine in a randomised clinical trial (RCT) the effectiveness of medication reminder apps on improving adherence to cardiovascular (CV) medication in a population with coronary heart disease (CHD). A secondary aim was to determine whether an advanced app is associated with higher adherence when compared to a basic app.
Methods: The MedApp-CHD Study was a RCT of 163 patients with CHD. All patients owned a smartphone (iOS or Android) and were recruited between May 2016 and May 2017. Patients were randomised to one of three groups: i) usual care (n=56), ii) a basic medication reminder app with no interactivity (n=54) or iii) an advanced medication reminder app with interactive and customisable features (n=53). A concealed, computerised randomisation was performed with a 1:1:1 allocation ratio. The primary outcome was the 8-item Morisky Medication Adherence Scale (MMAS-8) at 3 months. Secondary outcomes included blood pressure and cholesterol levels. The analysis of the primary outcome was performed comparing the basic and advanced apps' groups combined (combined app group) to the usual care group, using analysis of covariance with baseline values used as covariates. An additional analysis to assess whether there was a difference in adherence between the basic and advanced app groups was performed.
Results: The groups were well-matched at baseline, 88% were male, mean age was 58 (SD 8.9), mean number of CV medications was 4.2 (SD 1.02) and mean MMAS-8 score was 6.8 (SD 1.36). At 3 months, the mean MMAS-8 score was significantly greater (representing higher medication adherence) in the combined app group compared to the usual care group (mean difference 0.47, 95% CI 0.12 to 0.82, p 0.008). There was an increase of 0.29 in mean MMAS-8 score from baseline in the combined app group, while there was a decrease of 0.26 in mean MMAS-8 score in the usual care group. A comparison between the advanced and basic app groups showed no significant difference in MMAS-8 scores (mean difference -0.16, 95% CI -0.56 to 0.24, p 0.428). Figure 1 shows the proportions of patients in each level of adherence, categorised by MMAS-8 scores at 3 months. There were also no significant differences in the secondary outcomes.
Conclusion: Medication reminder apps improved self-reported medication adherence at 3 months in patients with CHD compared to usual care. An advanced medication reminder app was not associated with higher adherence compared to a basic app, indicating that the basic and advanced apps might be equally effective. This simple and scalable intervention has the potential to reduce non-adherence to CV medications.