How to Improve Medication Adherence With Mobile App

Why wonder if patients are taking their medications as directed when you can watch them do it? Samuel Holzman, MD, a clinical fellow in the division of infectious diseases at Johns Hopkins University School of Medicine, recently tested the effectiveness of a mobile app that patients use to video record themselves taking prescribed doses and send the videos to a secure server on the cloud for providers to view.

Dr. Holzman’s pilot study involved 28 patients who used the app to document their adherence to tuberculosis therapies. The app was well received by providers and patients alike and proved to be a cost-effective and convenient option for ensuring medication compliance. Dr. Holzman recently chatted about how the app is a new way to monitor patients’ adherence to prescribed medications and why it offers a glimpse into the future of technology-driven, patient-centered care.

What are the challenges of managing patients on long-term medications?

In our case, tuberculosis therapies are lengthy. Most patients take medications every day for six months, but therapies can last up to two years when resistant bacteria are involved. There’s also no blood test that can determine if patients are cured, so therapies have to be monitored closely and doses need to be counted to ensure the target number is reached.

The current gold standard for monitoring tuberculosis therapies involves having healthcare providers visit patients to watch them take their medications in person. You can imagine that process is challenging from a health system standpoint in terms of manpower and travel costs.

Here in Baltimore, for example, we typically visit 20 to 30 patients at any given time in various locations throughout the city. It’s also burdensome for patients, who must schedule visits during work or their personal time. Some patients with significant privacy concerns also don’t want healthcare workers showing up at their homes or places of work to watch them take medications. Overall, there’s a lot of room for improvement with the current monitoring system.

How does the app work?

It’s subscription based—patient must sign up for the service—and can be downloaded from any app store. The app also has a user-friendly interface. We were pleasantly surprised that most patients involved in the study had no problem figuring out how to use it. Patients open the app and are reminded to take the prescribed medication. The app then presents checkboxes for patients to indicate any adverse reactions they’re experiencing. Patients next see a screen with a small red button, which they push to video record themselves taking the medication. When they push the button again to stop recording, an encrypted video is automatically sent to a cloud-based server, where it can be viewed by a healthcare provider.

Similar medication monitoring apps use Facetime or Skype, but with those platforms providers must still schedule appointments to watch patients take medications in real-time. With this app, providers can view the cache of videos at their convenience.

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How does it benefit patient care?

There are several ways. Reminder texts are sent to patients who don’t submit videos and providers are alerted so they can follow-up to find out why doses are being skipped. Reported side effects are flagged and sent to providers, who check in with their patients about what they’re experiencing—the app essentially allows for the daily monitoring of medication-associated side effects.

For example, patients who experience a rash after taking a medication can show the reaction on the video they submit to their providers, who then determine if it’s something that requires follow-up care. The app lets providers monitor and document compliance with prescribed therapies on the weekends and if patients travel, which are times when in-person visits typically aren’t possible. Patients who have questions about what food to take with their medications or if splitting the dose is allowed can use the app to pose those questions to their providers.

It essentially improves the patient-provider interaction and pharmacists could certainly use this technology to better communicate with patients.

Are there any drawbacks to using the app to monitor medication compliance?

This approach is framed as active support to cheer patients long the course of their treatment. That can be very beneficial. However, there is a subset of patients who prefer the human touch of in-person visits. In addition, isolated, older patients might benefit from having a healthcare provider visit them on a daily basis. For those reasons, the app is not a one-size-fits-all solution.

The app doesn’t negate the benefit of in-person visits, but it presents a very important and very useful alternative for patients who find value in it. It should be made available to all patients, but its use must be based on the needs of individuals as part of a patient-centered care approach.

Can the app be used to care for patients with other diseases?

There are definitely broader applications for this technology. We’ve so far focused on using the app to improve the care of patients with tuberculosis, but our team is working on applying the platform to patients with other disease states. It will take new thinking before the technology takes hold. A few providers involved in the study who were often assigned to conduct in-person patient visits said they were concerned the app would displace their jobs. That’s an understandable reaction whenever a new technology is introduced, but it actually has the potential to save health systems money and let providers be more productive with their time. As mobile technology becomes more ubiquitous, it’s inevitable that apps like this will become part of a larger care management strategy. These types of mobile apps help tie patients to the healthcare system and allow them direct access to providers in a way that’s not overwhelming to for providers.

—Dan Cook

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