Let's Talk About Medication Reminders; My Research Project (e-Health)

If you were wondering why on earth would someone (a medical student) spent their time to write an article regarding mobile phone application, specifically, medication reminders, it is my current research project which I have to complete as a prerequisite of graduating from the medical school. At first, I keep on thinking that I'm totally screwed but as the time went by, I must admit, it is fun and kinda interesting.

Some info regarding why I have to venture into this kind of project as a medical student; in our medical school, we have a few categories of research that have to be completed in 1 year time (which is usually done before our final year). Each category can only be taken by a specified number of groups and in total, we have 40 plus groups (can't remember the exact total):

• Biochemistry
• Clinical project
• Community Research
• e-Health

Unfortunately for us, we have been assigned to e-Health and this is a new category which can only be taken by 2 groups out of the 40 plus. Obviously, we are the white mice and while I'm annoyed with the management, who expects a great outcome while giving a small amount of help (financial, transportation etc.), learning both medicine and programming in the same year is beyond what I could have described as "challenging".

We could have spent some amount of money, hiring developers who are specialised in this field but no, the department can't spend that much money on us as they have to segregate the overall budget with all of the 40 plus groups. Anyway, after discussing with our supervisor during the first meeting, we agreed to try and develop a medication reminder while trying to give it some sort of novel functions to improve adherence among patients.

Sounds simple, right? Maybe, if you are a mobile phone application developer or you are quite familiar with all of the required programming languages, but for a medical student? It's beyond terrified.

Medication Adherence

Before jumping into the apps review, let's talk about medication adherence among patients especially those with chronic diseases. I'm not talking about people who are taking antibiotics for 14 days due to a throat infection, no. I'm talking about someone who needs to commit to a long duration of treatment to alleviate symptoms of specific diseases. Tuberculosis can be one of the best examples of infectious diseases as patients need to take medication for at least 9 months.

Chronic diseases such as heart diseases, hypertension, diabetes mellitus etc. are on the rise among the elderly population. The cause can be attributed to multiple factors but most of them are due to age-related condition. In a paper published by Qato DM et al in 2008, elderly people are the largest consumers of medications in the United States, mainly because of age-related chronic diseases.

They were taking a buttload of medications that sometimes, we (medical practitioners) overlooked the probability of the prescribed drugs to cause mild to severe consequences when they were taken at the same time, in which, according to Qato, it was 1 out of 25 participants (4%). I'm not talking about drugs augmentation but simply major negative side-effect caused by the drug-drug interaction. This can be one of the many factors of poor adherence among patients who are required to take a lot of medications for their chronic conditions.

So what happens with people who are not compliance to whatever medication they were prescribed with? Simple, their condition would not improve and in the majority of cases, it will become worse. Some people need to take certain medications for the rest of their life to control symptoms and optimise their daily function and if they were to be non-compliance, it will put themselves, people surrounding them and medical practitioners in difficult situations.

People who carry HIV for example, they have to commit to a lifelong anti-retroviral therapy but according to a paper written by Heather B. et al which was published in November 2014, only 30% out of the total people who have been formally diagnosed that are compliant to their medications and follow up. This is a major concern as, without treatment, people with HIV can be highly infectious while showing no symptoms at all.

Hypertension and cardiovascular diseases can be managed by a variety of drugs which are usually prescribed according to the severity of disease processes. Without managing symptoms by committing themselves with medications, cardiovascular diseases could pose a high morbidity and mortality rate. There are a lot of studies which have been conducted to find the percentage of hypertensive patients who are non-adherent to their medication and the rate varied between 50 to 80% which are relatively high despite the fact that antihypertensive medications are safe with minimal side effects.

The reason for poor medication compliance can be attributed to a few reasons:

• Patient's factors
• Physician's factors
• Healthcare's system factors

Well, let's see. In my research, we are trying to focus on the patient's factor more than the latter. We are trying to alleviate patient's condition by making them compliance to their medication while omitting any reasons that might have stemmed from the patient themselves. For example, being forgetful. This is the primary reason why every medication reminder applications are being developed; to remind them what kind of medicine to take, when is the time to eat them and for some medication reminder, to remind patients when their medications are low in supply.

It's impressive how people can incorporate everything into a single application. Some diseases can be difficult to manage especially if patients have problems related to memories. The most difficult of all is when patients have poor insights into their diseases and the reason why they need to take their medications in the first place. I can't stress enough the importance of medical education among patient to ensure their commitment to a long-term treatment. If they understand the outcome of their diseases, they would become motivated to commit themselves, isn't it?

What about people with low income or came from a poor family background. It can be a problem for patients to be able to get their hands on the most high quality of medication when they have less to spend. Even more so, some people can't seem to buy a consistent supply of medication as they are financially disabled.

In Malaysia however, most of the medications are subsidised by the government. Some can get it for free and they are only required to pay a certain amount of money for the doctor's consultation fee (it is not expensive, really). If patients can't seem to keep up with their supply, then, that would mean they are not keeping up with their appointment as, without doctor's prescription, they can't get most of their medications. For the majority of situations, we can say that the outcome of certain diseases will depend on the patient's attitude towards those diseases.

How Far Can A Medical Reminder App Helps Patients?

Scrolling through the App Store, I must say, people did a very good job of keeping up with the functionality of their own medication reminder's app. In fact, some of them incorporate a certain benefit such as discount coupons for medications if they were compliance which will surely change the attitude of people towards taking their own medication at a certain time in the day. If you were punctual, then you can score a higher mark.

The problem is those applications can't really monitor how people were taking their medications. There are some medications which required a certain level of monitoring to ensure they were applied correctly; for example, eye drops. It's practically reasonable to assume that an effective mobile phone application is to incorporate a certain functionality that would be able to identify whether or not people are taking their own medication correctly.

Nevertheless, they were called medical reminder apps for a reason. They can only remind and whatever happens is none of anyone's concern. I mean, we can do so much for a patient and the majority roles should be assumed by them, not the phone's applications. People can lie to their phone apps stating that they have taken their medication when actually, they were ice skating in a mall.

I won't talk much about features but I would like to bring your attention to a medical reminder apps called Medify. It's a relatively simple medication reminder app with an added feature of taking the picture of a specific medication to be incorporated into a single alarm. When the alarm hit, it will display the picture of medications that you need to take.

This is relatively important especially for people who have a low degree of medical literacy. People sometimes can't discern between antihypertensive medications with others and if they took the wrong medication, it can lead to terrible consequences especially if they took a lot of them in a single day.

Some people have to take 5-8 types of medication a few times a day and they can easily get confused. It's convenient if every single time the alarm rang, the picture of a specific medication that they have to take appear as well. It's a simple yet important feature that can potentially change patients' attitude towards treatments of their own medical condition.

For now, I'm trying to make my medication reminder's app work. The alarm seems buggy and they worked differently with different phone models. Anyone who has ideas regarding features that are nice to be incorporated in the medication reminder's app, you can leave your comment below or if you want to make it discrete, you can e-mail me at [email protected].

References: [1], [2], [3], [4], [5], [6]

All images were taken from Pixabay

Images: [1], [2], [3], [4], [5], [6]