Improving Medication Adherence in HIV Patients Using Mobile Health Tools

Medication adherence is a problem across all patient populations. The cost of this non-adherence in the United States ranges between $100 billion to $289 billion annually. Lack of adherence can be caused by a variety of factors, including physical/mental, social, perceptual and logistical barriers. Among these physical/mental factors, forgetfulness is a major challenge for patients—especially those taking multiple medications, as well as older individuals with memory issues.

MOBILE HEALTH EMERGES AS A PLATFORM FOR ADHERENCE

One area that has shown early potential in impacting adherence is the mobile health technology space. The field of mobile health is growing exponentially in response to consumer demand. Studies show that more than 100,000 mobile health apps have already been published for smartphones, and the worldwide market for these applications has reached $2.4 billion. Consumers are also showing specific interest in using new tools for their medication management needs. More than 72% of all individuals recently surveyed said they would like to refill prescriptions through digital channels.

Mobile health technology is just one part of a growing trend toward greater data sharing in specialty pharmacies, with the goal of empowering physicians and engaging patients. The following illustration depicts how mobile health strategies may be deployed in these pharmacies—driving access to data across all systems and enabling integrations between the dispensing system, patient portal and mobile pharmacy apps.

Specifically, mobile apps may be of particular interest in HIV since they can serve as an “invisible” adherence tool, reducing the social stigma that might accompany electronic pill boxes and other specialized adherence devices. However, few studies have documented the measurable impact that these tools can make on adherence, medication discontinuation and outcomes overall. As a result, Avella Specialty Pharmacy and mscripts, a leading mobile health provider, have partnered to conduct a retrospective review that demonstrates how mobile health tools can significantly impact all of these areas. Download the complete case study.

METRICS USED TO TRACK ADHERENCE AND MEDICATION DISCONTINUATION

The study compared results across both groups based on a few important metrics and parameters included below:

1. Proportion of days covered (PDC) is the sum of days that a patient is in possession of ARVs within the measurement period divided by the total number of days in the measurement period.
2. A measurement period, for the purpose of this study, is defined through the following:
   • The last day of the measurement period is the last day of the most recent fill plus the total days’ supply.
   • The first day of the measurement period is the last day of the measurement period minus 180 days.
   • However, a measurement period is only valid if there is a fill date prior to the defined first date. As a result, PDC was only calculated for patients with a full measurement period for analysis.
3. For the purposes of measuring medication discontinuation, days to medication discontinuation was also assessed by taking the number of days from the index date to the end of the last fill plus the days’ supply before discontinuation. Discontinuation, then, is defined as greater than 30 consecutive days without coverage of prescribed ARVs.
4. 4. Index date is the first fill date that includes the first day of the PDC measurement period within the fill days supply window, or the first fill date after the first day of the PDC measurement period.

IMPROVED ADHERENCE AND LOWER MEDICATION DISCONTINUATION 

• HIV patients were 2.9 times more likely to be adherent when using the mobile app.
• On-platform patients had significantly better PDC than off-platform patients (0.918 vs. 0.878), though both were encouragingly high.
• A significantly larger proportion of on-platform patients had PDC of 0.90 or greater–the minimum needed to achieve viral suppression–compared to off-platform patients (79.0% vs. 65.3%).
• On-platform and off-platform patients had significantly different persistence curves, and a lower proportion of on-platform patients discontinued medication refills compared to off-platform patients (4.5% vs. 12.6%).

The following chart depicts the adherence results documented during the course of this study:

CONCLUSION 

Overall, these findings illustrate how new technology-enabled adherence tools can have a positive impact on medication adherence within HIV populations. Given the importance of promoting adherence for these patients, payers, providers and specialty pharmacies should carefully consider this strategy as part of an overall medication management plan. 

Overall, these findings illustrate how new technology-enabled adherence tools can have a positive impact on medication adherence within HIV populations. Given the importance of promoting adherence for these patients, payers, providers and specialty pharmacies should carefully consider this strategy as part of an overall medication management plan.

As mobile technology evolves and consumer demand for convenient, value-driven apps continues to rise, it is clear that the future of medication adherence will literally be in the hands of patients themselves.

The original version of this article was published in the summer 2015 issue of Dispensing Excellence. Download the latest issue to access the full digital copy of the publication and more information on mobile health technology and the impact on medication adherence.