When I prescribe a medication, I always have to ask the question: will this patient really take this medication? This is a fair question, as medical adherence (people taking medications as prescribed) is notoriously low - only 50% of people with longstanding disease take medication as prescribed. This leads to increased illness and results in a huge cost to society.
The reasons my patients give me for not taking their medications are:
- The medication is too expensive
- They can't remember to take it
- They don't understand why it's important to take it
- Taking the medication is too complicated.
While it's my job to prescribe medication patients can afford, explain why they are important, and keep things as simple as possible, getting patients to remember to take their pills is out of my control. So finding a tool to help them remember to take their medications is really important to me, as I want my patients to stay well, and my patients, as they like to stay away from my office.
Medcoach is my first candidate for this job. The app (available on iTunes) is made by GreatCall, Inc. and boasts the following features:
- Easily create a personalized medication list
- Receive reminders when it's time to take your medication
- Keep a log of your personal medication history
- Easily connect to your pharmacy when it's time to refill your prescription.
- View a history of your medication usage, making it easy to share with your doctor.
To test the product, I chose a patient who would be the best-case scenario for the app to work: an educated patient with good medical knowledge, and someone who loves using apps on his phone, which is, of course, me. I figured that any app that I found difficult would be a no-go for the average person, and so would not be worth sharing with my patients. Just like medications, any app I recommend has to actually be used by my patients.
This is the screen that meets the user upon first opening the app. Since I wanted to add a new medication, I tapped on the "medications" icon.
Here's what came up.
It allows the user to put in pills of any name, strength and frequency. I am concerned about the lack of safeguards to prevent input of incorrect frequency, which could make a medication ineffective or dangerous. I wondered if the med look-up would help, so I touched that box and got this:
This taps into a medication database of medications by brand and generic name. Clicking on the desired drug got me here:
This again does not prevent me from doing this:
And taking 900 Ex-Lax could cause problems. Scrolling down, I was met with this:
Which was confusing and difficult. There is no assumption I would take this every day, and no simple "twice daily" or "every 6 hours" as the medications are usually prescribed. Instead you are met with this:
And while I enjoy playing time roulette on my iPhone, it was a real pain to do for my medication. The final outcome was this:
Undaunted, I have used the app for several weeks (not with the medication shown above, I assure you), and have not benefitted from the reminders. I could just as easily have told Siri to remind me every morning at 12.27 AM to take my Ex-Lax (although she would have probably translated it to something like "shake my ex-wife" at 12.27 AM).
It is fitting that an app for prescription compliance demonstrates exactly what doctors shouldn't do. I was not compliant with this app because it complicated a task that could be easily done on a calendar. It offered no benefit in terms of medication dosing, and it doesn't safeguard against improper dosing. It did remind me of a refill that was due, but my pharmacy was already harassing me with phone calls about that. It also did not check for interactions, or give me information about the drug I was taking.
For me, the ideal app for medications would require the following:
- Very simple medication input. Ideally, this could come automatically from the physician's EMR or the pharmacy.
- Prevention of under or overdosage.
- Drug information (like dosing instructions, common side-effects)
- Drug interactions
It is not reasonable to expect patients to use this app, even though it's free. If you are compulsive enough to use this app properly, you probably don't need it.
Out of a possible score of 5, I give this:
If you have apps that you think I'd like (or ones you want me to ridicule in public) send me an email (rob at doctor-rob dot org). I enjoyed doing this. I think I might make it a habit.