MEDication reminder APPs to improve medication adherence in Coronary Heart Disease (MedApp-CHD) Study

INTERVENTION: There will be two different intervention groups as described below. 1) Basic app: Participants in the basic app group will be provided with and supported to access the basic app in addition to standard care. This app has basic features to provide daily simple timed reminders to take the medications with no further interactivity. The basic app will act similarly to an alarm or a text‐message by showing a reminder on the smartphone screen at a set time every day. Participants will be encouraged to set daily reminders to take each cardiovascular medication at the prescribed time. The duration of the intervention period will be 3 months. 2) Interactive app: Participants in the interactive app group will be provided with and supported to access the interactive app in addition to standard care. This interactive app has the ability to provide daily reminders to take medications and, in addition, it has more customisable and interactive features, including features to mark doses as taken or missed, to snooze the reminder, to interact and share data with family members and health professionals, multiple user support, adherence statistics, customisable alert sounds and visual cues like tablets and syringes icons. Participants will be encouraged to set daily reminders to take each cardiovascular medication at the prescribed time. In addition, participants will also be encouraged to track their doses daily by clicking in one of the following options every time a reminder pops‐up in the smartphone screen: taken on the schedule, taken on a different time, snooze or skip the dose. The duration of the intervention period will be 3 months. Information about engagement with the app will be obtained by extracting the adherence data from the app at the end of the study. These apps were selected through a stepwise approach to identify the best available apps to be tested in this trial. A comprehensive and systematic search of all available apps in the Australian iTunes and Google Play app stores was conducted and the apps were selected using a pre‐defined set of criteria. The highest quality apps were selected. Both apps are available for free in iTunes and Google Play stores and have ongoing technical support, having been recently updated in April 2016. CONDITION: Coronary Heart Disease PRIMARY OUTCOME: Medication adherence will be measured using the 8‐item Morisky Medication Adherence Scale (MMAS‐8). SECONDARY OUTCOME: Diastolic blood pressure measured using an automated electronic blood pressure monitor Acceptability of the intervention using a self‐reported survey designed for this study Health services utilisation through Medicare Benefits Scheme (MBS) data linkage LDL cholesterol measured on fasting blood samples ; INCLUSION CRITERIA: Participants will be eligible if they have a confirmed diagnosis of coronary heart disease, including a prior diagnosis of myocardial infarction, stable or unstable angina, coronary revascularisation procedure or current admission with an acute coronary syndrome event or >50% stenosis in at least one major vessel on the coronary angiogram. In addition, participants will have to meet the following criteria: 1) be an adult (> 18 years), 2) own an active smartphone that operates with iOS or Android operating systems, 3) have sufficient English skills, and 4) provide written informed consent. ; Medication adherence measured by prescription refill data obtained through Pharmaceutical Benefits Scheme (PBS) data linkage. Medication adherence to each and all indicated cardiovascular medications, including anti‐platelets, statin, angiotensin conversing enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) and beta‐blocker, measured by self‐report using a questionnaire designed specifically for this study. At the 3‐month follow‐up visit, a blinded researcher will ask the participants the names and dosages of all prescribed and over‐the‐counter medications currently being taken. Participants will also be asked the number of days that each indicated cardiovascular medication was missed in the week prior to the follow‐up visit. Participants will be defined as adherent if medication was taken for at least 6 days during the week preceding the study‐related visit, accounting for 85% of the days in that week. Participants not taking one of the indicated CV medication due to contra‐indications will be considered adherent. Systolic blood pressure measured using an automated electronic blood pressure monitor Total cholesterol measured on fasting blood samples