- How can a physician be sure that an elderly patient is taking their medication as assigned at the specified time? How can a caregiver be sure that their aging mother is taking her pills at the right dosage? These used to be significant issues for the pharmaceutical and healthcare industry, but today mobile health applications have paved the way for better drug adherence.
The mHealth field consists of many mobile health applications and a variety of these tools are able to help patients take the right drug dosage at the time specified by their doctor. To learn more about mobile health applications capable of improving drug adherence, mHealthIntelligence.com interviewed Daniel Mosby, junior doctor from England and Medisafe user.
mHealthIntelligence.com: Have mobile health applications really improved medication adherence among patients with chronic conditions?
Dr. Daniel Mosby: There’s a study recently released on the Medisafe website. From my personal experience, I started using Medisafe before I became a doctor so my first experience with Medisafe was as a patient. I’m a Type 1 diabetic as well. In the first place, for me personally, before I even go into being a doctor, it’s improved my health. It’s improved my adherence to my injections and, therefore, improved my blood sugar control and reduced my symptoms.
From a physician’s perspective, we’re now starting to see the proof that these apps work. As doctors, we like to practice evidence-based medicine so we like to see clinical studies and evidence that things work before we adopt them. My standards for recommending something for my patients and my standards for using something myself are a bit different.
For Medisafe, they recently did a study on hypertension and showed massive decreases in blood pressure and improvements in adherence to medication. The WHO released a report that showed the average adherence to medication in developed countries is about 50 percent for chronic health conditions.
Doctors don’t always think of adherence to medication. They think of prescribing the medication and how it will have an effect. Obviously, if the patient doesn’t take the medication, then it won’t have the effect. Adherence is quite an important thing.
With Medisafe, as opposed to the 50 percent figure from WHO, the figure is about 86 percent of people who are using Medisafe are adhering to medication. This was in a set of patients with hypertension. There’s definitely scope for these technologies to improve adherence. And, thereby, by improving adherence, it will improve the health of patients.
We still need more research and clinical studies. As the proof starts to mount, that’s going to push doctors into using these solutions.
mHealthIntelligence.com: What characteristics do mHealth apps and devices have that makes it easier for patients to take their medicine on time? Are there alerts?
DM: I can talk from my personal experience. What I like about Medisafe, it’s very persistent and easy to use. It’s almost like having an alarm clock next to your bed. You can snooze it forever. It will remind me every 10 minutes if I tell it I don’t want to take my medications right now.
It will remind me and remind me all day until I make sure I’ve taken those medications. It’s extremely rare I would forget medications nowadays compared to before. They’ve recently added a feature I liked where you’re able to directly send notifications that you’ve taken your medications via smartphone apps.
Aside from the 10-minute set up at the beginning where you have to enter your medications into the app and the frequency you taken them at, it really requires almost no intervention on the side of the user at all other than saying ‘yes, I have taken these medications.’
mHealthIntelligence.com: What are the most common medical conditions that mobile health applications could assist with drug adherence?
DM: We know hypertension is a big one. [Mobile apps would help patients with] any chronic health condition which can be improved by medication adherence. From my personal experience, diabetes is one.
I’ve also recommended Medisafe to my colleagues and friends who have diabetes as well. I had a particular patient recently who had presented diabetic ketoacidosis. This patient had not taken their insulin for two days simply because they’d forgotten to refill it.
However, the mobile app prompts you to refill your medications. So when you’re telling it that you’re taking your doses, it will tell you when your medications are running out and that you need to get more. This will impact long-term health in hypertension. For diabetes, if we don’t take our insulin for 24 hours, that could have serious health implications.
I could certainly extrapolate to more conditions in which Medisafe could be useful for. If I go back to the WHO report on medicine adherence, they covered quite a few chronic medical conditions. This could include epilepsy, cancer, depression and psychiatric conditions, and asthma. Also, patients who are diagnosed with HIV, they need to take regular antiretrovirals and missing doses can encourage resistance to these medications. That would be another condition I could imagine mobile apps to come in handy.
mHealthIntelligence.com: Where do you see the mobile health industry moving in the near future? In what other ways will it impact patient care?
DM: Basically, now that we have proof that these kind of applications have an effect, we need to build up more and more evidence so that clinicians are encouraged to use these and recommend these apps. For me, my experience with my diabetes, is that I would quite like more integration – apps talking to each other.
As a diabetic, my ultimate application would be an application that could record my blood sugars, bring me information from my fitness tracker, and it could record exactly how much insulin I’m administering and that would give me greater control over my diabetes.
I think we need to work more – rather on lots of individual apps for individual conditions – making apps become capable of talking to each other. Manufacturers of medical devices as well need to be more open with their software.
For example, I have an insulin pump that works via Blue Tooth so logic would dictate that I should be able to communicate with the insulin pump via my smartphone. However, the insulin pump will only communicate with another, less functional hand-held device that I have to carry around with me.
It would be far more convenient for me if it could communicate with my phone and then I could link in all the data from my fitness tracker. I’d have a much more integrated way of managing my diabetes.
In the UK, we have communications regulatory agencies and these often do surveys on smartphone use. We know that people who are 16 to 24 years of age, have about a 90 percent uptake of smartphones. However, people who are 65 years old and over, only have an 18 percent use of smartphones.
This is the market where more people will be suffering from chronic health conditions. It would be helpful to have caregivers managing and entering their relative’s medication into the application and controlling that themselves. We perhaps need to think more about how we can influence the older generation who are perhaps less tech savvy than the younger generations.