A mobile application improves therapy-adherence rates in elderly patients undergoing rehabilitation A crossover design study comparing documentation via iPad with paper-based control

Medication adherence is crucial for success in the management of patients with chronic conditions. This study analyzes whether a mobile application on a tablet aimed at supporting drug intake and vital sign parameter documentation affects adherence in elderly patients. Patients with coronary heart disease and no prior knowledge of tablet computers were recruited. They received a personal introduction to the mobile application Medication Plan, installed on an Apple iPad. The study was conducted using a crossover design with 3 sequences: initial phase, interventional phase (28 days of using the app system), and comparative phase (28 days of using a paper diary). Users experienced the interventional and comparative phases alternately. A total of 24 patients (12 males; mean age 73.8 years) were enrolled in the study. The mean for subjectively assessed adherence (A14-scale; 5-point Likert scale, from never to very often which results in a score from 0 to 56) before the study was 50.0 (SD=3.44). After both interventions there was a significant increase, which was more pronounced after the interventional phase (54.0; SD=2.01) than after the comparative phase (52.6; SD=2.49) (for all pairs after both interventions, P<0.001). Neither medical conditions nor the number of drug intake (amount and frequency of drug taking) per day affected subjective adherence. Logging data showed a significantly stronger adherence for the medication app than the paper system for both blood pressure recordings (P<0.001) and medication intake (P=0.033). The majority of participants (n=22) stated that they would like to use the medication app in their daily lives and would not need further assistance with the app. A mobile app for medication adherence increased objectively and subjectively measured adherence in elderly users undergoing rehabilitation. The findings have promising clinical implications: digital tools can assist chronic disease patients achieve adherence to medication and to blood pressure measurement. Although this requires initial offline training, it can reduce complications and clinical overload because of nonadherence.