Smartphone Medication Adherence Apps
Smartphone Medication Adherence Apps
According to the International Society for Pharmacoeconomics and Outcome Research (ISPOR), adherence is "the extent to which a patient acts in accordance with the prescribed interval, and dose of a dosing regimen." Medication nonadherence can affect patient health adversely, negatively impact a patient's relationship with his/her care provider, skew results of clinical therapy trials, and increase health resource consumption. Medication nonadherence remains a common health care problem. Poor adherence causes approximately 33% to 69% of medication-related hospitalizations and accounts for $100 billion in annual health care costs. Irrespective of disease, medication complexity, or how adherence is measured, the average adherence rate to chronic medication therapy is approximately 50%. Adherence monitoring should be performed routinely to ensure therapeutic efficacy, avoid unnecessary dose and regimen changes, contain health care costs, and in certain cases, prevent resistance to therapy from emerging.
Methods to measure adherence, including patient self-reports, pill counts, refill rates, biological monitoring, and electronic monitoring, have limitations and are only proxy measures. Patient self-reports rely on memory and are prone to inaccuracies and recall bias. Pill counts are unreliable if patients fail to return bottles or dump pills before the count. Biological monitoring (e.g., sampling blood, urine) is either impractical, invasive, or intrusive and does not measure adherence unless the time and dose administered before sampling are verified. Refill rates or electronic monitoring cannot determine whether patients actually take the medication. Although the process of cap removal does not necessarily reflect dose ingestion, medication electronic monitoring systems are useful for calculating adherence rates for dose taking and dose timing and often are viewed as the best method to measure adherence. Nonetheless, despite their limitations, all of these methods are adequate for documenting nonadherence, but in general, only self-report methods can distinguish among the various types of nonadherence described below.
The cause of medication nonadherence varies among patients and is broadly categorized as unintentional or intentional. Unintentional nonadherence involves intending to take a medication as instructed but failing to do so for some reason (e.g., forgetfulness, carelessness). Unintentional nonadherence is influenced by patient characteristics, treatment factors, and patient–provider issues. In contrast, intentional nonadherence involves making a reasoned decision not to take a medication as instructed based on perceptions, feelings, or beliefs. Intentional nonadherence reflects a rational decision-making process by the patient whereby the benefits of treatment are weighed against any adverse effects of the treatment. Broadly characterizing nonadherence may oversimplify the complexities involved with nonadherence, but it is practical and illustrates that mitigating nonadherence requires different interventions.
Most medication adherence models are based on several social cognition models, including the health belief model, social cognitive theory, and theory of planned behavior. These models are similar, and all assume that beliefs developed by individuals shape how they interpret information and experiences and ultimately influence their behavior. Accordingly, health behavior (e.g., medication taking) results from rational decisions based on all available information.
Medication Adherence
Epidemiology of Nonadherence
According to the International Society for Pharmacoeconomics and Outcome Research (ISPOR), adherence is "the extent to which a patient acts in accordance with the prescribed interval, and dose of a dosing regimen." Medication nonadherence can affect patient health adversely, negatively impact a patient's relationship with his/her care provider, skew results of clinical therapy trials, and increase health resource consumption. Medication nonadherence remains a common health care problem. Poor adherence causes approximately 33% to 69% of medication-related hospitalizations and accounts for $100 billion in annual health care costs. Irrespective of disease, medication complexity, or how adherence is measured, the average adherence rate to chronic medication therapy is approximately 50%. Adherence monitoring should be performed routinely to ensure therapeutic efficacy, avoid unnecessary dose and regimen changes, contain health care costs, and in certain cases, prevent resistance to therapy from emerging.
Measurement of Adherence
Methods to measure adherence, including patient self-reports, pill counts, refill rates, biological monitoring, and electronic monitoring, have limitations and are only proxy measures. Patient self-reports rely on memory and are prone to inaccuracies and recall bias. Pill counts are unreliable if patients fail to return bottles or dump pills before the count. Biological monitoring (e.g., sampling blood, urine) is either impractical, invasive, or intrusive and does not measure adherence unless the time and dose administered before sampling are verified. Refill rates or electronic monitoring cannot determine whether patients actually take the medication. Although the process of cap removal does not necessarily reflect dose ingestion, medication electronic monitoring systems are useful for calculating adherence rates for dose taking and dose timing and often are viewed as the best method to measure adherence. Nonetheless, despite their limitations, all of these methods are adequate for documenting nonadherence, but in general, only self-report methods can distinguish among the various types of nonadherence described below.
Types of Nonadherence
The cause of medication nonadherence varies among patients and is broadly categorized as unintentional or intentional. Unintentional nonadherence involves intending to take a medication as instructed but failing to do so for some reason (e.g., forgetfulness, carelessness). Unintentional nonadherence is influenced by patient characteristics, treatment factors, and patient–provider issues. In contrast, intentional nonadherence involves making a reasoned decision not to take a medication as instructed based on perceptions, feelings, or beliefs. Intentional nonadherence reflects a rational decision-making process by the patient whereby the benefits of treatment are weighed against any adverse effects of the treatment. Broadly characterizing nonadherence may oversimplify the complexities involved with nonadherence, but it is practical and illustrates that mitigating nonadherence requires different interventions.
Behavioral Models of Adherence
Most medication adherence models are based on several social cognition models, including the health belief model, social cognitive theory, and theory of planned behavior. These models are similar, and all assume that beliefs developed by individuals shape how they interpret information and experiences and ultimately influence their behavior. Accordingly, health behavior (e.g., medication taking) results from rational decisions based on all available information.
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