Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge

Bettina Habib; David Buckeridge; Melissa Bustillo; Santiago Nicolas Marquez; Manish Thakur; Thai Tran; Daniala L Weir; Robyn Tamblyn

doi:10.1093/jamiaopen/ooab050

Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge

JAMIA Open. 2021 Jul 31;4(3):ooab050. doi: 10.1093/jamiaopen/ooab050. eCollection 2021 Jul.

Authors

Bettina Habib¹, David Buckeridge^{1

2}, Melissa Bustillo¹, Santiago Nicolas Marquez¹, Manish Thakur¹, Thai Tran¹, Daniala L Weir^{1

2

3}, Robyn Tamblyn^{1

2

4}

Affiliations

¹ Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.
² Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
³ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
⁴ Department of Medicine, McGill University Health Center, Montreal, Canada.

Abstract

Objective: The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM's potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events.

Materials and methods: We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up.

Results: Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%).

Conclusion: The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial.

Trial registration: Clinicaltrials.gov, registration number NCT04676165.

Keywords: adverse events; medication adherence; mobile application; pilot randomized controlled trial.

Associated data

ClinicalTrials.gov/NCT04676165