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

Objective To determine whether the Perx app improves medication adherence and clinical outcomes over 12 months compared with standard care in patients requiring polypharmacy.Design Randomised controlled trial with 12-month follow-up.Setting Outpatient clinics in three tertiary hospitals in Sydney, A...

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Autores principales:	Kyra Sim, Ian Caterson, Ang Li, Michelle Cunich, M Gail Del Olmo, Mackenzie Fong, Sharyn J Lymer
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/26f67240e8ad49a28da15f15e0e981cf
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spelling	oai:doaj.org-article:26f67240e8ad49a28da15f15e0e981cf2021-11-29T01:30:05ZEffect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial10.1136/bmjopen-2020-0470412044-6055https://doaj.org/article/26f67240e8ad49a28da15f15e0e981cf2021-08-01T00:00:00Zhttps://bmjopen.bmj.com/content/11/8/e047041.fullhttps://doaj.org/toc/2044-6055Objective To determine whether the Perx app improves medication adherence and clinical outcomes over 12 months compared with standard care in patients requiring polypharmacy.Design Randomised controlled trial with 12-month follow-up.Setting Outpatient clinics in three tertiary hospitals in Sydney, Australia.Participants Eligible 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.Interventions The intervention group used the Perx app that contained customised reminders and gamified interactions to reward verified medication adherence.Main outcome measures The 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).Results Of 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.Conclusions This 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 number ACTRN12617001285347.Kyra SimIan CatersonAng LiMichelle CunichM Gail Del OlmoMackenzie FongSharyn J LymerBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 11, Iss 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Kyra Sim Ian Caterson Ang Li Michelle Cunich M Gail Del Olmo Mackenzie Fong Sharyn J Lymer Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial
description	Objective To determine whether the Perx app improves medication adherence and clinical outcomes over 12 months compared with standard care in patients requiring polypharmacy.Design Randomised controlled trial with 12-month follow-up.Setting Outpatient clinics in three tertiary hospitals in Sydney, Australia.Participants Eligible 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.Interventions The intervention group used the Perx app that contained customised reminders and gamified interactions to reward verified medication adherence.Main outcome measures The 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).Results Of 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.Conclusions This 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 number ACTRN12617001285347.
format	article
author	Kyra Sim Ian Caterson Ang Li Michelle Cunich M Gail Del Olmo Mackenzie Fong Sharyn J Lymer
author_facet	Kyra Sim Ian Caterson Ang Li Michelle Cunich M Gail Del Olmo Mackenzie Fong Sharyn J Lymer
author_sort	Kyra Sim
title	Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial
title_short	Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial
title_full	Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial
title_fullStr	Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial
title_full_unstemmed	Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial
title_sort	effect of a smartphone application (perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/26f67240e8ad49a28da15f15e0e981cf
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Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial

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