In the “Journal of Medical Internet Research mHealth and uHealth” a team of researchers from the Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine have published a paper claiming there is insufficient evidence to support the cost effectiveness of SMS/App based medication adherence in adolescents with chronic conditions.
I’m surprised by the findings of this paper because nearly ten years ago I asked a NHS GP friend to poll his Patients about the use of their mobile for medication reminders and he couldn’t find any female Patients who didn’t already use a ZERO COST DIY medication adherence app (a simple alarm/calendar/app set up to remind them to take their pill).
Medication adherence is such a huge and complex problem costing economies like the US hundreds of billions of dollars per year so it should be obvious that a simple one size fits all SMS/App won’t come along and definitively put an end to the issues. Equally if a genius does manage to crack such a manifest problem with a mHealth app you can be sure she will not be prioritising the publication of a research paper that proves the cost effectiveness of this new approach because it’s not very glamorous (eg. while I’ve read about countless dreamers talking up big data, wearables and Virtual Reality etc I’ve not once seen Urologist Dr Robert Flynn invited to present at a major Healthcare innovation conference or written up in Healthcare journals even though he published in 2011 evidence that conclusively proved the cost effectiveness of SMS appointment reminders – which are related to adherence as Patients with the lowest adherence levels are probably those who also don’t attend their appointments) and if it works there are millions of really smart Carers who will want to adopt it right away regardless of the cost effectiveness because what we’re doing today is clearly not cost effective.
To find results for a paper like this I think the researchers should focus on areas where adherence is being effectively twinned with financial incentives eg. we all know that connected glucometers take the guess work out of diabetes testing and effectively end the billions that are lost/wasted on diabetes test strips.
I would recommend researchers in this area engage with entrepreneurs who are actually working in this business – you can find a great list of them in the mHealth networking group introductions thread – because analysis of published papers is unlikely to yield results as these are only really going to be helpful for rear view market evaluation (eg. analysing evidence for the cost effectiveness of dated adherence interventions that don’t leverage the tools of our time and increasingly make no sense to the next generation).
Another area I would study would be the work of pharma retail giants like Walgreens and McKesson as they have huge financial incentives in getting this right (eg. the Walgreens mHealth app generates +$B’s/year and did more business in it’s first 12 months than Walgreens.com had managed online in the previous 10 years). A particularly valuable area I think researchers could learn lots from analysing would be the situation we have here in Ireland where a mHealth medication adherence service developed by the largest pharmacy retail brand (owned by McKesson) produced a model that was so successful the Health Service Executive charged the company with fraud.