- Smartphones apps are often promoted as promising tools to help people manage their chronic conditions, but a new study in JAMA Internal Medicine raises questions about their ability to change behaviors and outcomes.
- The researchers randomized 411 adults with poorly controlled high blood pressure to either receive the Medisafe smartphone app or serve as controls. The goal was to see if medication adherence improved when patients had easy access to reminder alerts, adherence reports and optional peer support.
- While those in the test arm had a small improvement in self-reported medication adherence, there was no difference in blood pressure compared with controls.
At 12 weeks, self-reported medication adherence among patients with the app had improved on a widely used medication adherence scale but was unchanged among controls. Mean systolic blood pressure was down 10.6 mm Hg in the app group and 10.1 mm Hg for controls.
Nonadherence accounts for close to half of all cases of poorly controlled hypertension and more than half of cases deemed to be “medication-resistant,” the authors wrote.
Just why improvements in adherence didn't translate to improvements in blood pressure is unclear. Patients who received the Medisafe app may have been more motivated to self-report, but the increase may have been too small to trigger changes in blood pressure, the authors suggest. They note that the change in the intervention group is well below the minimum change needed to detect clinical benefit from antihypertensive medication adherence.
Patients also likely need to be highly adherent to their medications to see a benefit. That wasn't the case in this study, as improvements in adherence were mainly among patients who moved from low to moderate compliance.
“While the app we tested has received very high usability scores, it may be that individuals with hypertension have needs that are different from those of individuals with other conditions,” the authors wrote. “Therefore, one solution is to offer more disease-specific customization of smartphone tools.”