The value of medication adherence technologies in pharmacy practice in Croatia: the APLiK study and the Meddox mobile app
Results of a research collaboration on implementing a digital medication adherence solution in real-life practice
During visits to primary or secondary care, patients often refer to documentation (medical records, opinions, examination results) that is not available when needed. Some documentation is left at home but can be retrieved, while some is irretrievably lost by patients. The problem identified by the Meddox team a few years ago was how to securely, simply, and practically store patients’ medical documentation so that it is always at hand and can be shared with interested parties when needed.
Meddox as an answer
The answer to the described problem was achieved by designing and implementing the Meddox mobile application. The application allows each user to store their medical documentation and the medical documentation of others (family members or people they care for) via an application installed on a mobile device (mobile phone or tablet).
Aspects important for Users and Healthcare Professionals
The initial benefit for users and the healthcare system is obvious – all medical documentation is available at any time. In addition to being available to the user, selected documents can be shared with third parties via email or social networks, solving one of the main system functioning problems and giving users the ability to manage their documentation.
Another interesting aspect of the application’s functionality is the implementation of an OCR algorithm that recognizes and classifies data relevant to users and the system, such as diagnoses, findings, or therapy presented in a manner understandable to professionals (coded according to the ICD and ATC systems) and descriptively, in a way understandable to the user.
Integrating Meddox solution to ENABLE Platform
Thanks to dr. sc. Iva Mucalo, Associate Professor at Faculty of Pharmacy and Biochemistry from University of Zagreb, who recognised Meddox in early stages and its value when it comes to improving medication adherence, Meddox was one of the first technologies added to ENABLE Repository of Medication Adherence Technologies.
The APLiK study
Adherence to prescribed treatment regimens is a critical factor in the management of chronic diseases, significantly influencing health outcomes and healthcare costs.
Despite the availability of effective treatments, many patients struggle with adherence due to factors such as complex medication regimens, side effects, and lack of education. With this in mind, we designed as study titled “Adherence as a Measure of the Active Role of Patients and Pharmacists in the Treatment of Chronic Diseases (APLiK)”. The study aimed to evaluate how the use of the Meddox mobile app impacted adherence to prescribed therapies. Principal authors of the study were Martina Šepetavc, MPharm from biggest Croatian pharmacy chain “Farmacia”, Zagreb, Croatia and Pero Hrabač, Md PhD from School of Medicine, University of Zagreb and Meddox associate, who presented the study on Annual Congress on Pharmacy in May 2024, in Dubrovnik, Croatia.
The study was conducted from February to April 2024 across 17 pharmacy locations within the Pharmacy chain “Farmacia”, Croatia, involving a total of 98 participants over 18 years old over 90 days, involving a series of up to four visits to participating pharmacies. Patients involved had to be currently on chronic therapy continuing for at least three months from the start of the study, and able to understand the study’s requirements and follow the instructions provided by the investigators. All participants had the Meddox mobile application installed on their smartphones, which was used to track their medication adherence.
The study compared adherence rates across different patient demographics and conditions, with the primary outcome being the proportion of patients demonstrating adherence to their prescribed chronic therapy. Secondary analyses explored factors influencing adherence, such as age, gender, and geographic location. Such design aims to provide insights into the factors affecting adherence in chronic disease management and the role that digital tools can play in supporting patient adherence.
The majority of the participants were female (63.3%), with ages ranging from 20 to 84 years. Participants visited the pharmacy one to three times during the study period, with 66.7% making only one visit, 29.9% making two visits, and 3.4% making three visits. Participants generally presented with one or more comorbid conditions, with 58.2% having two or more chronic illnesses in addition to their primary condition. At the initial visit, the baseline adherence was already high, with the majority of participants showing significant compliance with their prescribed treatment regimens. After implementing the Meddox application, a marked improvement in adherence was observed. Between the first and second visits, adherence rates increased by 12%, demonstrating the potential impact of digital tools in supporting patient compliance. This improvement continued, albeit more modestly, between the second and third visits, with a 1% increase in adherence rates. The use of the Morisky Medication Adherence Scale (MMAS-8) provided a standardized measure of adherence, with scores improving consistently across the study period. These results underscore the role of pharmacists in reinforcing adherence and the added value that digital tools like Meddox can bring to chronic disease management.
The role of digital engagement tools
The study’s findings suggest that while the initial adherence among the study population was high, the introduction of the Meddox application further enhanced compliance, particularly in the short term. Although the increase in adherence slowed between the second and third visits, the overall trend was positive. This indicates that digital tools can be a valuable aid in managing chronic conditions, although they do not replace the critical role of pharmacists. Instead, they serve to complement the pharmacists’ efforts, helping to maintain and improve patient adherence over time.
The results highlight the importance of continued support and education for patients with chronic illnesses, and the potential benefits of integrating digital tools into pharmacy practice to achieve better health outcomes. An article manuscript is in preparation to be submitted to a peer-reviewed journal for publication early 2025. Further research is recommended to explore the long-term effects of such interventions and to identify the most effective strategies for sustaining high levels of adherence.
