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Original research article
Medication reminder applications to improve adherence in coronary heart disease: a randomised clinical trial
  1. Karla Santo1,2,3,
  2. Anna Singleton1,3,
  3. Kris Rogers2,4,
  4. Aravinda Thiagalingam1,3,5,6,
  5. John Chalmers1,2,4,
  6. Clara K Chow1,5,2,3,
  7. Julie Redfern1,2,3
  1. 1 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 The George Institute for Global Health, Sydney, New South Wales, Australia
  3. 3 Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
  4. 4 Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  5. 5 Cardiology Department, Westmead Hospital, Sydney, New South Wales, Australia
  6. 6 Cardio-respiratory Division, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
  1. Correspondence to Dr Karla Santo, Westmead Applied Research Centre, The University of Sydney at Westmead Hospital, Sydney, NSW 2154, Australia; ksanto{at}


Objective The aim of the MEDication reminder APPs to improve medication adherence in Coronary Heart Disease Study was to evaluate the effectiveness and feasibility of using publicly available high-quality medication reminder applications (apps) to improve medication adherence compared with usual care in patients with coronary heart disease (CHD). An additional aim was to examine whether an app with additional features improved adherence further.

Methods Patients with CHD (n=163) were randomised to one of three groups: (1) usual care, (2) a basic app or (3) an advanced app with interactive/customisable features. The primary analysis compared usual care versus app use on the primary outcome of the 8-item Morisky Medication Adherence Scale (MMAS-8) at 3 months. Secondary outcomes included blood pressure and cholesterol levels.

Results The mean age was 57.9 years and 87.7% were male. At 3 months, patients using an app had higher adherence (mean MMAS-8 score 7.11) compared with the usual care group (mean MMAS-8 score 6.63) with a mean difference between groups of 0.47 (95% CI 0.12 to 0.82, p=0.008). There was no significant difference in patients using the basic app versus the advanced app (mean difference −0.16, 95% CI −0.56 to 0.24, p=0.428). There were no significant differences in secondary clinical outcome measures.

Conclusion Patients with CHD who used medication reminder apps had better medication adherence compared with usual care, and using apps with additional features did not improve this outcome further. These data suggest medication apps are likely to help patients with chronic health conditions adhere to medicines, but further examination of whether such benefits are sustained is warranted.

Clinical trial registration number ACTRN12616000661471; Results.

  • medication adherence
  • coronary heart disease
  • mhealth
  • smartphone
  • apps

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  • Contributors KS, CKC, JC and JR conceived the original concept of the study and obtained the funding. KS, AS, AT and CKC were involved in the data acquisition. KS, AS and KR performed the statistical analysis. KS drafted the manuscript. All authors have read and approved the final manuscript.

  • Funding This study was supported by a Vanguard Grant (ID101464) funded by the National Heart Foundation of Australia (NHFA). KS was funded by a University of Sydney International Postgraduate Research Scholarship. JC is a chief investigator on National Health and Medical Research Council (NHMRC) programme grant (ID1052555). CKC is funded by a Career Development Fellowship cofunded by NHMRC and NHFA (APP1105447). JR is funded by a Career Development and Future Leader Fellowship co-funded by the NHMRC and the NHFA (APP1061793).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from the Western Sydney Local Health Network Human Research Ethics Committee (HREC/1/WMEAD/3).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets used and/or analysed during the current study are not publicly available due to data sharing not being approved by the local ethics committee but are available from the corresponding author on reasonable request.