mHealth App Improves Kidney Medication Adherence, Engagement

A newly developed mHealth app for chronic kidney disease (CKD) care improved patient engagement and medication adherence based on a new study published in CJASN.

The interactive smartphone app, eKidneyCare, is synced with pharmacies and includes a feature that prompts CKD patients to review medications monthly. Then, the app sends any changes, additions, or medication problems to clinicians for resolution.

The mHealth app was designed to drive medication adherence through patient engagement in CKD management. Adverse drug reactions (ADRs) are common among CKD patients. It is estimated that 32 percent of serious ADRs could be prevented by addressing medication discrepancies, or differences between the patient’s reported medication history and the clinic’s record.

The researchers set out to find if mHealth technology could be employed to improve proper medication adherence and drive better patient safety.

In a year-long trial, 182 outpatients with advanced CKD were randomly assigned a smartphone preloaded with either the experimental intervention, eKidneyCare, or a commercially available app for health information storage that’s the usual course for care.

At the end of the trial, the researchers measured the rate of medication discrepancy, finding that the eKidneyCare group had been successful in improving medication adherence.

eKidneyCare users had a 0.45 medication discrepancy rate compared to the commercial app cohort’s rate of 0.67.

The medication discrepancy rates for clinically relevant medications (any medication related to CKD treatment) were similar; 0.33 for the eKidneyCare group compared to .50 for the control group.

Lastly, the eKidneyCare group saw much lower rates of medication discrepancies that had the potential for serious harm (0.27 compared to 0.63 for the control group).

Usage data revealed that 72 percent of patients in the eKidneyCare cohort completed at least one medication review per month. Only 30 percent of patients in the commercial app group kept their medication information on their phone.

“In this one-year study, we demonstrated the sustainability of the intervention and showed that this high level of patient engagement reduced the rate and severity of medication discrepancies, an indirect indicator of improved medication safety,” said study co-author Alexander G. Logan, MD, FRCP(C) in a press release.

The study authors recognized eKidneyCare may have been successful because it requires patient participation in their care. Patients may have a stronger feeling of responsibility in maintaining an up-to-date medication list.

Additionally, eKidneyCare takes medication management beyond the traditional medication reconciliation process that occurs at in-person visits. This allows for an open communication channel between patients and their clinical team in the time between appointments so that providers can make early interventions regarding medication discrepancies to prevent ADRs.

“It has been posited that the lack of patient-clinician communication or the patient’s inability to communicate medication-related concerns may account for more than half of preventable ADRs in ambulatory care,” the study authors wrote.

What’s more, eKidneyCare eliminates medication data silos, which have been shown to magnify medication errors. Instead, all users have access to a common clinic pharmacy database. Secure communication channels connect all stakeholders—the provider, the patient, and the pharmacist—so that issues surrounding medication safety can be mitigated.

“The integrated process of medication review and the synchronization of the patients’ apps with the clinical pharmacy database also ensured that patients using eKidneyCare always had an updated medication list on their smartphone,” the study authors noted.

These study results show that mHealth technology can engage patients remotely in medication reconciliation and maintain involvement for over a year.

“The high rate of use of the medication feature in eKidneyCare throughout the study suggests patients perceived value in using it, and willingly accepted the responsibility of being involved in medication reconciliation,” the researchers wrote. “eKidneyCare also captures the trend toward increased home management of chronic conditions, now spurred on by the COVID-19 pandemic, and demonstrates the feasibility of conducting medication reconciliation without the necessity of face-to-face interviews.”