Impact of a Smartphone App Reminder on Adherence to Aspirin Prescribed as Antithrombotic Therapy

Abstract

BACKGROUND: Many patients are discharged with aspirin (ASA) as an anticoagulant after joint replacement surgery. In studies in which ASA was prescribed, doses were frequently missed. Adherence to postoperative ASA regimen is critical to preventing thrombotic complications. This randomized controlled study evaluated the impact of an existing medication adherence smartphone application (app) on adherence to twice daily ASA 81 mg for 35 days after knee or hip arthroplasty. METHODOLOGY: Patients were randomized to either the app (intervention) group or the usual care (control) group. All patients received a baseline interview with a survey and demographics collected prior to randomization, a 36-day follow-up call for phone pill count, and a 6-week in-office interview with surveys and an in-person pill count. A convenience sample of 195 patients enrolled; 122 completed pill counts at both baseline and end of study. Ages ranged from 29 to 89 (mean: 60.4, SD: 10.1) years. The majority had a bachelor's degree or higher (59.3%), made more than $75,000 (or were retired; 51.9%), were of White race (75.9%), and female (53.8%). There were no significant demographic differences between the groups. RESULTS: There were no significant group differences in final pill counts, adherence (reasons for missed pills), or ASA Medication self-efficacy scores. However, the intervention group scored significantly higher on the ASA Adherence measure (general ease in and ability to take ASA; p = .020). Higher ASA Adherence scores were associated with lower pill counts at the end of study (better adherence) in the intervention group. There was a high rate of attrition related to failure to bring the ASA to hospital or to the follow-up appointment. CONCLUSIONS: Although there were no significant differences in final pill counts between groups, the app group reported more ease in taking pills. With smartphone use virtually ubiquitous, this project provided an opportunity to educate patients and nurses about how technology can support medication adherence. It was also an excellent opportunity to involve clinical nurses in a funded research project.

Expanding Role of Technology in Rehabilitation After Lower-Extremity Joint Replacement

“…van Dijk-Huisman et al conducted a randomized controlled trial of 97 patients undergoing TJA and found that patients who used a smartphone app with an accelerometer in addition to standard physical therapy stood and walked for 28 minutes longer on postoperative day 1 compared with patients who received standard physical therapy alone 38 . Wittig-Wells et al reported that a medication-adherence smartphone app could lead to higher medication adherence in their randomized controlled trial of 195 TJA patients 39 .…”

“…Eight studies [31][32][33][34][36][37][38][39] showed that electronic adjuncts may impart some benefit to TJA patients. Day et al conducted a prospective study of 34 patients undergoing THA or TKA who received mobile phone messages regarding activity and pain-control reminders starting 1 week prior to surgery until 2 weeks after surgery 31 .…”

Smartphone Apps for Managing Antithrombotic Therapy: Scoping Literature Review

“…Wittig-Wells et al [ 29 ] described results from a prospective open-label trial evaluating the effects of a mobile app with reminders on adherence to antiplatelet therapy in patients after hip or knee alloplasty. There were 195 patients enrolled, and 122 completed the pill count at the end of the follow-up.…”

Acceptability, feasibility, and effectiveness of smartphone‐based delivery of written educational materials in Iranian patients with coronary artery disease: A randomized control trial study

“…Previous studies showed that the use of new technologies such as mobile applications as one of the influential factors in promoting medication self‐efficacy. 43 , 44 Achieving the same results, despite the use of different tools as well as variety of interventions and methods of using the smartphone capabilities, can be attributed to the fact that the information technology and internet advances as well as numerous advantages such as easy access, availability at any time and place, communication and information transfer capability, 45 facilitate the learning process, and improve the information satisfaction, as one of the factors affecting patient satisfaction is the teaching method. 46 Thus, as learning enhances, patients receive more information about their disease and can participate effectively in their treatment course.…”

“…Similarly, Park et al's 42 also supported the effectiveness of mobile‐based education in promoting adherence to antiplatelet drug therapy during the 30 days of vulnerability after myocardial infarction or percutaneous coronary interventions. Previous studies showed that the use of new technologies such as mobile applications as one of the influential factors in promoting medication self‐efficacy 43,44 . Achieving the same results, despite the use of different tools as well as variety of interventions and methods of using the smartphone capabilities, can be attributed to the fact that the information technology and internet advances as well as numerous advantages such as easy access, availability at any time and place, communication and information transfer capability, 45 facilitate the learning process, and improve the information satisfaction, as one of the factors affecting patient satisfaction is the teaching method 46 .…”