Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial

• Published in: BMJ open Vol. 11; no. 8; p. e047041
• Main Authors: Li, Ang, Del Olmo, M Gail, Fong, Mackenzie, Sim, Kyra, Lymer, Sharyn J, Cunich, Michelle, Caterson, Ian
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 09.08.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Blood pressure; Cardiovascular disease; Cholesterol; Chronic illnesses; Clinical outcomes; Creatinine; Diabetes; diabetes & endocrinology; Fasting; general medicine (see internal medicine); Health Informatics; Heart failure; Hemoglobin; High density lipoprotein; Hospitals; Intervention; Kidney diseases; Lipids; Lipoproteins; Pathology; Patient compliance; Polypharmacy; Smartphones; Telemedicine; Thyroid gland; Triglycerides
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-047041

ObjectiveTo determine whether the Perx app improves medication adherence and clinical outcomes over 12 months compared with standard care in patients requiring polypharmacy.DesignRandomised controlled trial with 12-month follow-up.SettingOutpatient clinics in three tertiary hospitals in Sydney, Australia.ParticipantsEligible participants were aged 18–75 years, with at least one chronic condition, taking ≥3 different medications (oral medications or injections), with smartphone accessibility. Participants were randomised in a 1:1 ratio.InterventionsThe intervention group used the Perx app that contained customised reminders and gamified interactions to reward verified medication adherence.Main outcome measuresThe primary outcome was medication adherence over 12 months measured using pill counts. Secondary outcomes included clinical outcomes (haemoglobin A1c (HbA1c), cholesterol, blood glucose, triglycerides, creatinine, thyroid function, blood pressure and weight).ResultsOf 1412 participants screened for eligibility, 124 participants were randomised; 45 in the Perx arm and 40 in the control arm completed the study. The average age was 59.5, 58.9% were women, chronic conditions were cardiovascular disease (78%), type 2 diabetes (75%), obesity (65%) or other endocrine disorders (18%). On average, participants were taking six medications daily. The Perx group had greater improvements in adherence at month 2 (Coef. 8%; 95% CI 0.01 to 0.15), month 3 (Coef. 7%; 95% CI 0.00 to 0.14) and month 12 (Coef. 7%; 95% CI 0.00 to 0.13). The probability of HbA1c ≤6.5% was greater in the Perx group at months 9 and 12 and cholesterol (total and low-density lipoprotein cholesterol) was lower in the Perx group at month 3. The intervention was particularly effective for those with obesity, taking medications for diabetes and taking ≤4 medications.ConclusionsThis study provides evidence that app-based behavioural change interventions can increase medication adherence and produce longer-term improvements in some clinical outcomes in adults managing multimorbidity. More trials are needed to build the evidence base.Trial registration numberACTRN12617001285347.