In the US, medication nonadherence costs more than $100 billion annually. Medication adherence applications (apps) are a new resource to help patients manage their medication regimens and potentially improve adherence. However, there are hundreds of medication adherence apps making it difficult for patients and providers to identify quality apps. In 2012, an initial study found 160 medication adherence apps available to consumers.

• The medication adherence app market has more than doubled in the past two years and continues to offer apps with high variability in terms of app quality• No app possessed all desirable author-identified features; however, several apps were highly rated across all four domains• Sharing this information with healthcare providers and consumers could enable them to find a quality app that may improve their medication adherence

• 461 medication adherence apps were initially identified across the three marketplaces• 367 apps were available for evaluation after removing Lite/Trial versions and apps that were specific to a single medication or disease state• The mean initial score based on the product description was 26.7 and ranged from 23-47 (max of 68)• Of the 100 apps eligible for testing, 19 were excluded because they failed to produce medication reminders or could not be installed by at least one author, which included all of the Blackberry apps, leaving 81 apps for testing• The mean user-tested score was 27 and ranged from 13-50 (max of 68)• Compared to the initial scores, 39 (48%) user-tested scores increased, 35 (43%) user-tested scores decreased, and 7 (9%) user-tested scores were unchanged

Navigating the Flooded Adherence App Marketplace:Rating the Quality of Medication Adherence AppsCatherine Renna, Rebecca Shilling, Seth Heldenbrand, PharmD, Lindsey Dayer, PharmD, BCACP, Bradley C. Martin PharmD, PhD

• Online marketplaces (iTunes, Google Play, and Blackberry App World) were searched for medication adherence apps during June of 2014• Inclusion criteria: English language apps capable of generating medication reminders• Apps limited to a single disease state or medication were excluded• 28 author-identified desirable app features were divided into four domains and assessed from developer descriptions • Each feature was assigned a score based on their importance in their respective domain (1-modest; 2-moderate; 3-high) • Apps with Lite/Trial versions were treated as one product• The 100 highest scoring apps were eligible for testing and were evaluated by two authors against developer claims• Each app was evaluated over a four day period using a standardized six drug regimen: vitamin E once daily, diltiazem twice daily, simvastatin once daily at bedtime, azithromycin once daily for three days, prednisone three day taper, and alendronate once weekly• Apps were then re-ranked based on user-tested score

CONCLUSIONS

• Development of a searchable adherence app website in order to alleviate the frustrations of identifying quality apps in the online marketplaces • App effectiveness could be diminished if designed without health literacy in mind; therefore, the addition of a health literacy domain could help in identifying apps with the highest patient usability

• To assess the smartphone medication adherence app market by evaluating available apps based on descriptions in the marketplace and testing the performance of the highest-scoring apps against developer claims

• Dayer L, Heldenbrand S, et al. Smartphone medication adherence apps: potential benefits to patients and providers.  J Am Pharm Assoc.  2013; 53( 2): 172– 81

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