Evidence map›Paper›PMID 34373299›Full record

Trial reportBMJ open2021

Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial.

Ang Li, M Gail Del Olmo, Mackenzie Fong, Kyra Sim, Sharyn J Lymer, Michelle Cunich, Ian Caterson

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Smartphone application-based interventions for cardiometabolic risk factor management: A systematic review and meta-analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Pooled it
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  4. Smartphone application-based intervention to lower blood pressure: a systematic review and meta-analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2025
    Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Ang LiBoden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia ang.li5@unimelb.edu.au.ORCID 0000-0002-6269-6432
M Gail Del OlmoBoden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Mackenzie FongBoden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Kyra SimBoden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Sharyn J LymerBoden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Michelle CunichBoden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Ian CatersonBoden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine whether the Perx app improves medication adherence and clinical outcomes over 12 months compared with standard care in patients requiring polypharmacy.

designRandomised controlled trial with 12-month follow-up.

settingOutpatient clinics in three tertiary hospitals in Sydney, Australia.

participantsEligible participants were aged 18-75 years, with at least one chronic condition, taking ≥3 different medications (oral medications or injections), with smartphone accessibility. Participants were randomised in a 1:1 ratio.

interventionsThe intervention group used the Perx app that contained customised reminders and gamified interactions to reward verified medication adherence.

main outcome measuresThe primary outcome was medication adherence over 12 months measured using pill counts. Secondary outcomes included clinical outcomes (haemoglobin A1c (HbA1c), cholesterol, blood glucose, triglycerides, creatinine, thyroid function, blood pressure and weight).

resultsOf 1412 participants screened for eligibility, 124 participants were randomised; 45 in the Perx arm and 40 in the control arm completed the study. The average age was 59.5, 58.9% were women, chronic conditions were cardiovascular disease (78%), type 2 diabetes (75%), obesity (65%) or other endocrine disorders (18%). On average, participants were taking six medications daily. The Perx group had greater improvements in adherence at month 2 (Coef. 8%; 95% CI 0.01 to 0.15), month 3 (Coef. 7%; 95% CI 0.00 to 0.14) and month 12 (Coef. 7%; 95% CI 0.00 to 0.13). The probability of HbA1c ≤6.5% was greater in the Perx group at months 9 and 12 and cholesterol (total and low-density lipoprotein cholesterol) was lower in the Perx group at month 3. The intervention was particularly effective for those with obesity, taking medications for diabetes and taking ≤4 medications.

conclusionsThis study provides evidence that app-based behavioural change interventions can increase medication adherence and produce longer-term improvements in some clinical outcomes in adults managing multimorbidity. More trials are needed to build the evidence base. TRIAL REGISTRATION NUMBER: ACTRN12617001285347.

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 2AdultBlood PressureFemaleHumansMedication AdherenceMiddle AgedSmartphonediabetes & endocrinologygeneral medicine (see internal medicine)health informaticstelemedicine

Identifiers

PMID34373299
PMCPMC8354275

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.