- Healthcare professionals and mHealth app designers must identify ways to make medication adherence apps produce improvements in wellness measures, indicates a new study published in the Journal of the American Medical Association. Currently, patient engagement with mHealth tools are not improving clinical outcomes for hypertensive patients.
Medication non-adherence is a patient engagement issue that seriously hinders chronic disease management, said the research team.
“While many factors contribute to poorly controlled hypertension, nonadherence is thought to account for nearly half of all such cases,” the team noted. “In fact, among patients classified as having ‘medication-resistant’ hypertension, more than 50 percent are actually nonadherent to their prescribed medications.”
mHealth apps have potential to reduce medication non-adherence by delivering patient reminders for taking medications and refilling prescriptions, tracking adherence, offering patient education, and creating optional peer support, the researchers asserted.
In addition to these benefits, mHealth adherence apps are very accessible for most patients because there are numerous on the market. Between 2012 and 2015, the number of medication apps available increased by 515 percent. There are 107 medication adherence mHealth apps specializing in hypertension medications alone.
As such, medication adherence apps should be able to close the wellness gap for patients managing hypertension, the research team posited.
A control trial of the Medication Adherence Improvement Support App For Engagement—Blood Pressure (MedISAFE-BP) among 412 patients with hypertension showed that the app can work to improve medication adherence.
The 206 patients who used the Medisafe app observed improvements in self-reported medication adherence, which was measured on a scale of zero to eight. After the 12-week study period, the mean adherence score for these intervention patients improved by 0.4, while there was no observable improvement for the 206 control patients.
But those improvements in medication adherence did not yield improvements in systolic blood pressure in either group. Average blood pressure measured at 151.4 (9.0) mm HG and 151.3 (9.4) mm Hg for intervention and control patients, respectively.
By study’s end, systolic blood pressure decreased by 10.6 (16.0) mm Hg among intervention participants and 10.1 (15.4) mm Hg among control patients. These are negligible improvements, the researchers said.
There are a number of explanations as to why medication adherence improved but blood pressure did not, the team explained.
“Readings from home blood pressure monitoring devices were used to determine trial eligibility and evaluate outcomes,” the team said. It is possible that the reductions in blood pressure from baseline to the end of follow-up that we observed in both the intervention and control arms may have resulted from fluctuations in these home blood pressure readings and/or regression to the mean, and that the magnitude of these changes was larger than the a priori hypothesized effect from the smartphone app.”
Additionally, all patients were required to submit home readings of blood pressure monitoring results, totaling to about 9 or ten readings during the study period. In this way, all patients were at least somewhat self-monitoring and aware of their overall blood pressure and health. This may have influenced other wellness behaviors among both groups.
There is also the chance that the app simply did not yield a substantial enough change to improve patient health.
“Alternatively, while we observed a statistically significant improvement in adherence from the intervention, the magnitude of this change was likely too small to translate into improvements in blood pressure,” the researchers observed.
The medication adherence measure typically needs a two-point change to yield a measurable improvement in blood pressure control. This means that the patient must be highly adherent to their hypertension medications to produce any statistically significant improvement.
There is also the chance that self-reported medication adherence was not the most applicable measure of app efficacy. Patients using the app may have perceived their adherence as improving because they were using the app, when in reality they were not becoming more adherent. Patients may also have needed more time with the app to yield more noticeable changes in blood pressure.
Going forward, there are a number of areas in which the team could improve patient use of a medication adherence mHealth app. The tool could be more specific to hypertension patients, which would in turn assist them with their specific health goals, the team said.
“While the app we tested has received very high usability scores, it may be that individuals with hypertension have needs that are different from those of individuals with other conditions,” the researchers concluded. “Therefore, one solution is to offer more disease-specific customization of smartphone tools. An alternative idea is to link the app to clinical care.”