M edication-related problems are a significant and often undetected health care issue outside of formal medication review services. These problems can delay or prevent clinical improvements and may result in preventable harm. Electronic medication management systems within hospitals are largely assumed to reduce such harm; however, as described by Westbrook and Baysari elsewhere in this Supplement, 1 the evidence for this is limited. Digital technologies for consumers extend the scope of care beyond health organisations and may offer an additional avenue for reducing medication-related problems. While there are several non-digital strategies that help people take their medicines correctly (eg, dose administration aids, home medicines reviews and pharmacy services), digital technologies such as medication management apps and wearable sensor devices can potentially also support medication management by consumers. However, despite this potential, and the launch of smartphones more than a decade ago, consumerdirected digital health tools are seldom used in clinical practice.
Medication management: there are (too many) apps for thatOne of the barriers to adoption of digital technologies for medication management is navigating the overcrowded market. A review conducted in 2017 identified more than 800 medication management apps designed to support medication adherence, available from the Windows, iTunes, Google Play and Blackberry app stores. 2 Current medication management apps utilise different strategies to improve medication use, and can be roughly segregated into three categories: education techniques, reminder and management techniques, and behavioural techniques. 3 Education techniques include interactive content, such as structured texts and videos. Reminder and management techniques include options such as alarms, push notifications and short message service (SMS) alerts. Behavioural techniques include personal tracking, where users monitor their own use; external tracking, where data are shared with a health professional, family member or friend to create social accountability and promote the desired behaviour; and gamification, where rewards such as badges or points, are provided for high level adherence.A review of 420 free medication adherence apps conducted in 2018 found the majority (59.5%) employed one mechanism to promote medication adherence, 35.5% used two mechanisms, while only 5.2% used all three mechanisms. 3 Use of reminders was the most popular feature, with 92.1% of all medication adherence apps having some kind of reminder functionality. 3 With regard to behavioural techniques, the authors found that personal tracking was the technique most commonly included, with external tracking and gamification relatively uncommon (5.2% and 1.2%, respectively). 3 It is unclear whether these findings are applicable to paid apps, as they were excluded from this analysis.Studies suggest that app quality varies greatly. The above evaluation of over 800 free and paid apps resulted in a median quality score (bas...