Long-term adherence to medication is critical when it comes down to successfully treating chronic diseases. However, according to the World Health Organization (WHO), only about 50% of patients in developed countries who suffer from chronic diseases adhere to treatment recommendations, and this is even lower in developing countries. Nonadherence to long-term therapies can impede treatment success and the overall effectiveness of healthcare systems while increasing morbidity and death rates. The development of mobile health applications, or “mHealth” apps, aiming at improving medication adherence has increased sharply in the past few years; however, their effectiveness and feasibility for integration into the healthcare system remains to be evaluated.
The results of the MedISAFE-PB trial, which evaluated the effectiveness of Medisafe smartphone app on medication adherence and blood pressure (BP) control among patients with poorly controlled hypertension, were published on April 16, 2018. According to the authors, medication nonadherence accounts for about half of uncontrolled hypertension, and over 100 smartphone apps are already available to assist in self-management of hypertension alone. Despite the wide availability, improved BP control through smartphone technology has been demonstrated only for those mHealth strategies that aim to improve communication between patients and physicians, even though most patients download and use apps without the active participation of their physician.
The MedISAFE-BP trial was the first study to report the effect of a “stand-alone” mHealth platform designed to improve BP control through increased medication adherence. The Medisafe app, marketed by Medisafe Boston and Israeli digital health business, is available on both iOS and Android and includes reminder alerts, adherence reports, and optional peer support. This digital solution has been named top app for medication management by November 2017 IQVIA (Quintiles IMS) report and received endorsements from the American Pharmacy Association, Journal of Medical Internet Research (JMIR), and Ranked Health, and has received the highest usability rating among medication adherence smartphone apps in several reviews.
The use of the Medisafe smartphone app showed a small statistically significant improvement in self-reported medication adherence, but it did not result in improved BP control in patients with uncontrolled hypertension compared with the control group. Although the results were disappointing in terms of clinical outcome, this should be a valuable piece of information for the increasing list of companies investing in mHealth strategies to improve medication adherence and outcome. Indeed, on March 27, 2018, Merck KGaA—a leading science and technology company—announced a collaboration with Medisafe to help its cardiometabolic patients better manage medication intake and adhere to prescribed treatment regimens.
The improvement in self-reported medication adherence using Medisafe could have been too small to see a clinically meaningful improvement in BP control. Furthermore, limitations of the “stand-alone” digital mHealth tool could have contributed to the lack of more meaningful results, since several studies have shown greater effects on clinical outcomes when home self-monitoring of BP was linked with connection to health care professionals.
Nevertheless, the substantial growth of the adherence app market reflects a high demand for this tool, requiring a continued need for randomized controlled trials to identify those apps that could be effectively incorporated into current care. Although active involvement of nurses and pharmacists are effective measures of improving medication adherence, they are highly resource intensive. Therefore, GlobalData believes that smartphone adherence apps will play important role in improving adherence to medication and provide better quality of life for patients living with chronic conditions.
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