Physician review of Pillboxie, a medication reminder app for patients

By: Kathy Nieder MD
Patient Centric App Review Series
Goals of app review:

• To determine if Pillboxie has the potential to be used by patients for reminding them to take their medications on time.
• To determine if there is any evidence to suggest this app would be useful for patients and physicians to use together.

Introduction: 
The more medications a patient is on, the more difficult it is to remember to take them.
According to the World Health Organization  only 50% of patients in developed countries adhere to treatment regimens.
This is particularly true when patients are on complicated regimens that involve taking pills two to three times daily.
Patients and caretakers could potentially benefit from apps that assist in remembering which meds to take and when.
Pillboxie is an app created by Jared Sinclair, also a RN, whose goal was to develop an attractive design that allows the user to “visually” manage medications by dropping representative pills into a pillbox marked with the corresponding time(s) for taking them.
When the program is first opened there is a seven “page” instruction on how to use the program. This can be reaccessed from the settings page.

Opening screen shows visual representation of the medications the user is taking. Once a medication is checked off it is grayed out.

Medications are entered by typing in the name, choosing a shape, color, schedule, reason for taking and instructions.

User can enter notes, time and dose taken as well as how the patient felt after taking it.

Healthcare Goals:

This app’s purpose is to remind patients to take their medications, hoping to improve overall compliance.

Evidence to Support Goals:

Using PubMed and Google Scholar, we were unable to find studies that have examined the use of smartphones apps for medication adherence. We found studies that have conceptualized the idea[PDF], but these studies did not have subjects. We used the following search phrases and keywords in PubMed and Google Scholar: “Medication reminder app” /”medication reminder iPhone”/ “medication compliance app” / “iPhone medication compliance”.
The use of text messaging alerts has been studied and indicate improved compliance with meds when patients get regular reminders [1], showing there is potential that alarm-based reminders from a medication app could serve the same purpose, increasing compliance.

Price:

• $0.99

Likes:

• “Gamification” feel, visually interesting
• Supports multiple users
• Opening screens on first use explain how to use the app
• Allows multiple users
• Passcode enabled
• Multiple means of support-email or twitter
• Alerts pop-up even if the device is asleep

Dislikes:

• Dosages are not a required field when recording medication
• No printable or email-capable list of medications
• No flexibility in “nagging” feature

Suggested Additional Features:

• “Oval” pill choice
• Aforementioned medication log suitable for printing

Ease of Use:

• Two clicks maximum to any screen where data is entered
• Well-arranged opening screen
• Good value for price

Bottom Line:

This is a visually pleasing app that could potentially help patients remember to take their medications. However, there is no data to definitely suggest this app would help improve patient outcomes. One of the most essential features this app lacks is the ability for patients to print or email a medication list for their provider.

Prescribing this app to a Patient and Concerns:

As Physicians, one of the biggest concern of prescribing this app to a patient is technology failure. If a patient relies on their app exclusively for reminders, and if their app stopped working all of a sudden because of some bug or error, then they could potentially miss a key reminder — causing them to develop hypertensive emergency or worse complications. App errors are not a benign phenomenon — the recent failure of app updates was not even caused by developers, but by Apple itself.
Also, the developer of this app, a registered nurse, should be applauded for creating such a clean and useful app. At the same time, this could potentially be looked at as a weakness in the app in regards to support and IT. If a larger company, such as Medtronic were to create an app, they have an army of developers and 24/7 support if something were to go wrong with the app. Unfortunately, the same sort of resources are not available to individual app developers.
These are all things to consider before considering prescribing this app to a patient.
iTunes link
References: 
1. Impact of a Text Messaging Pilot Program on Patient Medication Adherence, Kalee F. Foreman, Karen M. Stockl, Lisa B. Le, Eric Fisk, Sameer M. Shah, Heidi C. Lew, Brian K. Solow, Bradford S. Curtis, Clinical Therapeutics May 2012(Vol. 34, Issue 5,Pages 1084-1091)

This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your health care provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or health care provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your health care provider.