Effectiveness of a Drug Reminder Mobile Phone Application in Adhering to Uric Acid Lowering Therapy in Patients with Gout: An Open-Label, Randomized Controlled Trial

Abstract Background: Most patients with chronic diseases have difficulties adhering to treatment,leading to unfavorable outcomes and anincreased healthcare burden. Our objective wasto evaluate the effectiveness of a drug reminder mobile phone application (app) in the adherence of patients to uric lowering therapy (ULT) in patients with gout with poor adherence. Methods: We conducted an open-label,randomized controlled trial in 54 gout patients who had serum uric acid (SUA) greaterthan 6 mg/dL and poor adherence to ULT. The patients were randomly assigned to the reminder app "Drug diary" (N =25) or the patient education app "Roo-Rak-Koh" (N =29). The co-primary end points were the proportion of patients with high ULT adherence, based on the Medication Taking Behavior measure for Thai Patients (MTB-T) questionnaire, the percentage of adherence to the pill count, and the proportion of patients who achieved the SUA target (< 6 mg/dL). A stable dose of ULT was required throughout the study. Results: At 12 weeks, the proportion of patients with high ULT adherence and the percentage of pill count were significantly higher in the drug reminder app group (63% vs 37%, p = 0.047 for MTB-T and 96% vs 93%, p=0.04, for pill count), while the SUA target was achieved in 48% and 47.8% in the drug reminder app group and in the patient education app group, respectively (p = 0.89). However, SUA reduction in SUA was significantly greater in the drug reminder app group (-1.63 ± 1.18 vs -0.76 ± 1.24, p = 0.01). Conclusion:Mobile phone health applications can improve medical adherence in patients with chronic diseases requiring long-term medical treatment. In addition to drug reminder, optimal gout education also significantly improves gout care. Trial registration: Thai Clinical Trial Registry (TCTR), TCTR20200123002. Registered 23 January 2020,http://www.thaiclinicaltrials.org/show/TCTR20200123002