INTRODUCTION:

Medication adherence is essential to patient treatment and is required to achieve clinical goals. The degree to which people take their medications exactly as directed by their medical professionals is known as medication adherence. When patients take their prescriptions as directed, they take their medications:

· In the right dose

· At the right time

· In the right way

Medication adherence is essential because, when patients don't take their prescribed medications as directed, their chances of developing diseases, being admitted to the hospital, and passing away rise.

Even with the quick progress in drug discovery, the percentage of chronic disease patients in advanced countries who do not take their medications as prescribed is still between 40% and 60%.

Medication non-adherence is a complicated problem with numerous contributing factors, which can be categorized into two categories:

· Individual-related (i.e., forgetfulness and low health literacy skills) and

· medication related (i.e., increasing dosage, increased number of medications, poor communication skills of provider, and lack of medication review by provider)¹

43.5% reported low adherence, 28.7% reported medium adherence, and 27.8% reported high adherence.

Lower age, male gender, living in an urban area, having a higher income category, and having a job were all substantially linked to low adherence. Patient-related causes accounted for the majority of nonadherence (62.9%). Of these, the most common patient-related causes were forgetfulness (18.6%) and fear of reliance (13.9%).²

Assessing how digital health technologies influence adherence is crucial since they provide creative approaches to overcome these challenges.

WHAT ARE DIGITAL MEDICATION ADHERENCE SYSTEMS?

Patients can better manage their prescription schedules and adhere to recommended treatments with the use of technology-based digital medication adherence systems. To track and monitor medicine usage and adherence, these systems usually make use of wearable technology, smartphone apps, or other digital tools. They can assist in patient-provider communication by sending out warnings and reminders. By lowering the possibility of medication-related errors and problems, these systems aim to enhance patient outcomes and assist patients in better managing their chronic diseases. ³

Table 1: Examples of Digital Medication Adherence Technologies

Technology	Functionality	Examples
Mobile Health Apps	Medication reminders, tracking, education, EHR integration	MyMeds, Medisafe, Pill Reminder
Wearable Devices	Monitors vital signs, tracks medication intake	Fitbit, Apple Watch
Remote Patient Monitoring (RPM)	Monitors patient health remotely	Tytocare, iHealth
Telehealth Services	Provides remote consultations and monitoring	Amwell, Doctor on Demand
Artificial Intelligence	Personalized interventions based on data analysis	AI-driven chatbots and decision support systems

TRANSFORMING MEDICATION ADHERENCE THROUGH DIGITAL INNOVATIONS:

The quick development of digital technology in recent years has created previously uncommon chances to interact with patients and encourage better health behaviours like medication adherence. Although the ways and methods of these techniques vary greatly, they can be categorized under the general notion of digital health, or eHealth, which is described as "health services and information enhanced or delivered via the Internet and related technologies."

Figure 1: Various digital health technologies

Digital health technologies comprise a broad range of instruments intended to help health management and enhance results. Important technologies consist of: ^{4, 5}

a. Mobile Health Applications (mHealth Apps)

b. Information and Communications technology (ICT)

c. Telehealth Services

d. Wearable Devices

e. Remote Patient Monitoring (RPM)

f. Artificial Intelligence (AI) and Machine Learning

a. Mobile Health Applications (mHealth Apps):

The smartphone and its widespread accessibility have caused a fast transformation in the way users monitor their health over the past few decades. Software programs that operate on tablet or smartphone platforms are referred to as mobile apps. Apps can also help patients with chronic illnesses better adhere to their treatment plans or manage their medical problems.

Software programs developed specifically for tablets and smartphones that make maintaining health easier are known as mobile health applications. Important characteristics consist of:

· Medication Reminders: To assist patients in taking their medications on schedule, a number of applications provide customisable reminders. Refill notifications may be included in these reminders, which can be customized based on the prescription regimen.

· Tracking and Monitoring: Patients have the ability to track and monitor their medicine intake over time by keeping records. Certain applications include graphical representations, including graphs and charts, which help users in understanding their patterns of adherence.

· Educational Resources: A lot of applications offer information on drugs, including possible interactions, adverse effects, and how crucial adherence is. Patients' understanding of their treatment programs may improve as a result.

· Health Record Integration: A few smartphone apps enable the easy sharing of prescription updates and histories between patients and doctors by linking with Electronic health records (EHRs).

· Support Communities: Several applications come with chat or forum functions that let users interact with others going through comparable medical issues, creating a feeling of support and community.

To enhance healthcare services, the Indian government has launched a number of mHealth initiatives, including the Vaccine Tracker app, India Fights Dengue app, Swasth Bharat mobile app, National Health Portal, E-RaktKosh, etc.^6,7,8

Figure 2: Mobile Health Application

b. Information and Communications technology (ICT):

ICT additionally contributes significantly to the advancement of healthcare technology in India by providing effective means of information access, communication, and storage. In order to provide value-based healthcare, clinical, biological, telemetry, and environmental data are combined with IoT in healthcare and healthcare data analytics to provide a smooth patient journey. It also facilitates communication between health researchers and medical practitioners, as well as between health professionals and the people they serve. For instance, if a patient contracts a tropical illness while traveling overseas and the local doctor is unable to diagnose it, he can use information and communication technology (ICT) to instantly share the symptoms with doctors located anywhere in the world and receive assistance with the diagnosis, enabling him to successfully treat the patient and broaden his own knowledge base.

c. Telehealth Services:

The use of communications technology to deliver medical care remotely is known as telehealth. The combination of innovations in medical technologies, computer science, informatics, and communications has made telehealth a precious asset. Interactions between patients and doctors place via phone, email, video calls or conferences, the Internet, and remote devices, and comprise a wide variety of practices and specialties under the banner of telehealth. Telehealth lowers the need for travel and queues, improves efficiency without increasing net costs, gives people living in remote or underserved locations access to services and care, and enables equal or better quality of care. Patient satisfaction can also rise with the usage of telehealth due to easier access to care, convenience, and decreased stress.^9,10

· Virtual Consultations: Patients and healthcare professionals can engage in real-time conversations on adherence to medications and treatment approaches through video or live chat.

· Constant Monitoring: Telehealth systems enable clinicians to monitor patient progress and adherence from a distance, enabling prompt interventions when problems occur.

· Follow-Up Care: Telehealth streamlines regular follow-up appointments, removing the need for travel and making it easier for patients to keep ongoing connection with their healthcare teams.

· Accessibility: By providing assistance and monitoring more available, telehealth improves access to care for patients living in underserved or rural areas, which may improve adherence.

d. Wearable Devices:

They have been widely used in healthcare applications by sensing motion and tracking individuals. Ultimately, the usage of motion sensors can help in revealing possible information about an individual’s health. The potential of wearable technology, such as fitness bands and smartwatches, to improve compliance with medications is becoming more widely acknowledged. Numerous capabilities that promote patient involvement and health care can be offered by these technologies.

Real-time data on blood sugar, pulse, sleep duration, respiratory problems, and drug concentrations can be continuously accessed with these devices. This enables people to keep an eye on their health without regularly visiting medical facilities, and it can also instantly notify users of crises.

Among other things, wearable technology is used to detect and record when medication bottles are opened, detect when a medication is ingested, and send out alert lights, vibrations, or auditory alarms to users or their smartphones/tablets to improve medication adherence.¹¹

Table 2: Key Features of Wearable Devices for Medication Adherence

Feature	Benefit
Medication reminders	Alert patients at scheduled times
Real-time health data	Tracks vitals like heart rate and sleep patterns
Integration with apps	Syncs with mHealth apps for comprehensive monitoring
Alerts for missed doses	Notifies both patients and providers of missed medications

Figure 3: Digital Health Technology System. (A) Inertial measurement unit, which monitors mobility. (B) Smartwatch which assesses self-reported medication adherence, by notifying participants when to take their medication and allowing them to log the time at which they took their medication. (C) Smartphone which collects contextual data

e. Remote Patient Monitoring (RPM):

The ability of clinicians to monitor and manage patients in unique medical conditions has improved with the implementation of remote patient monitoring (RPM). RPM employs digital tools to gather health data from people in one place, such as a patient's house and sends it electronically to medical professionals in another region for review and advice. More precisely, to enhance medical decision-making, non-invasive technologies are increasingly frequently incorporated into wellness plans to supply extra patient data.

While other technologies may require the patient to submit their health data through a secure website, smartphone, or personal digital assistant (PDA), some non-invasive technology, such as biosensors or wearables, may be programmed to gather and transmit health data without doing anything from the patient. These devices frequently record clinical data on vital signs, weight, blood pressure, oxygen saturation, and heart rate.

Utilizing wearable technology and smartphone apps, remote patient monitoring (RPM) continuously monitors health indicators and medication compliance, giving medical professionals access to data in real time. With the help of this technology, continuous monitoring is made possible, enabling fast treatments in response to changes in health or non-adherence. In order to empower people to take charge of their own health care, RPM offers patient engagement tools like educational materials and feedback systems. Predictive analytics also finds patterns in adherence, allowing for proactive treatment, and integration with electronic health records (EHRs) provides a whole picture of the patient's health. RPM improves patient outcomes and medication adherence overall by providing individualized support and ongoing monitoring.^12,13

f. Artificial Intelligence (AI) and Machine Learning:

By improving the administration of drug adherence, artificial intelligence (AI) and machine learning (ML) are revolutionizing the healthcare industry. These technologies analyze huge amounts of data, spot trends, and offer useful insights by using sophisticated algorithms.

Medication adherence is improved by artificial intelligence (AI) and machine learning (ML) because of a number of important aspects. Through the analysis of demographic and medical history data, predictive analytics helps healthcare providers strategically interact with patients who are at high risk of non-adherence. Customized training and customized reminders are two examples of personalized therapies that guarantee patients receiving help that fits their unique preferences and routines. By analyzing input and evaluating mood, Natural Language Processing (NLP) helps improve patient communication by highlighting issues or obstacles to adherence. AI also works with digital health devices, such wearables and mobile health apps, to combine data from various sources for thorough patient insights and to track adherence in real time. When combined, these methods offer an innovative, tailored strategy for enhancing drug compliance.

Early identification of treatment protocol non-adherence is a major method AI is enhancing outcomes for patients. Artificial intelligence (AI) algorithms are able to recognize patterns that suggest non-adherence by examining enormous volumes of information, such as wearable device data, patient feedback, and electronic medical records. These algorithms are able to identify minute alterations in behaviour or biometric data that could indicate a treatment plan diversion. Early detection enables medical professionals to take quick action and address possible problems before they worsen and become unmanageable. ^{14, 15}

FUTURE DIRECTIONS IN DIGITAL HEALTH TECHNOLOGIES:

Digital health technologies have revolutionized the healthcare landscape, particularly in enhancing medication adherence. These technologies provide innovative solutions that improve patient engagement and therapeutic outcomes. As we look to the future, several key developments are anticipated that will further enhance the impact of digital health on medication adherence.^16,17

1. Integration of Artificial Intelligence (AI):

The incorporation of AI into digital health technologies is expected to refine personalized medicine approaches. AI algorithms can analyze vast amounts of patient data to identify adherence patterns and predict potential non-adherence. By leveraging machine learning, these systems can tailor interventions to individual patients, such as sending personalized reminders or educational content based on their specific behaviours and preferences.

2. Wearable Technology Advancement:

The evolution of wearable technology will play a significant role in medication adherence. Future wearables may not only track physical activity and vital signs but also monitor medication intake through smart pill bottles or ingestible sensors. These devices can provide real-time feedback to both patients and providers, fostering accountability and encouraging adherence.

3. Telehealth Expansion:

Telehealth services have become more popular since the COVID-19 epidemic, and this trend is predicted to continue. Future telehealth platforms may integrate advanced features such as virtual reality consultations or remote monitoring capabilities that allow healthcare providers to assess patient adherence more effectively. This expansion will enhance access to care, particularly for patients in remote areas.

4. Data Privacy and Security Enhancements:

As digital health technologies proliferate, ensuring data privacy and security will be paramount. Future developments should focus on implementing robust cybersecurity measures and transparent data-sharing practices to build trust among patients. Ensuring that patients feel secure in sharing their health data will be crucial for the success of digital health interventions.

5. Patient-Centered Design:

Future digital health technologies should prioritize user-centered design principles to enhance usability for diverse populations. This includes considering factors such as age, technological proficiency, and cultural differences when developing applications and devices. By tailoring solutions to meet the needs of various patient demographics, adherence rates are likely to improve.

6. Real-Time Feedback Mechanisms:

Implementing real-time feedback mechanisms within digital health tools can significantly enhance medication adherence. For example, apps could provide instant feedback on medication intake or alert healthcare providers if a patient misses a dose. This immediate response can help address adherence issues before they escalate.

7. Community Engagement Platforms:

Future digital health technologies might also include community engagement features that connect patients with peers facing similar health challenges. Support groups facilitated through apps or online platforms can provide encouragement and motivation for patients struggling with adherence, fostering a sense of belonging and shared experience.

CHALLENGES AND BARRIERS:

Enhancing drug adherence could be greatly aided by the addition of digital health technology, such as smartwatches, telemedicine platforms, and health apps for mobile devices. Nevertheless, a number of difficulties and obstacles may prevent them from being widely used to be successful. This is a thorough examination of these challenges like:

Key Barriers to Medication Adherence:

· Digital Literacy: A lot of patients are not skilled in using technology for digital health. Patients with poor computer skills may not be able to properly utilize apps or gadgets meant to help with drug adherence, which could eventually compromise their efficacy.

· Access to Technology: Differences in accessibility to the internet, smartphone ownership, and various other digital resources can limit the efficacy of digital health technologies. Patients residing in rural locations or with less privilege may have considerable challenges when utilizing these technology.

· Privacy and Security Concerns: There are serious privacy concerns when sensitive medical data is stored. Compliance attempts may be affected by patients' reluctance to embrace digital health services because they are concerned about privacy risks or the exploitation of their private information.

· Complexity and Usability: A number of digital health products may be extremely complicated or difficult to use, which can cause annoyance and disinterest. People are less likely to use these tools regularly if they are challenging to operate.

· Dependence on Technology: Dependence on technologies might cause issues if there are malfunctions or outages in the systems. These delays may result in missed doses or lapses in adherence, which would negate the purpose of these instruments.^18,19

CONCLUSION:

Advances in digital health technologies have the potential to improve adherence to medications and facilitate a patient-centered approach to healthcare. We are able to customize treatments to match specific demands by giving priority to AI and machine learning-driven customized remedies. To comprehend the long-lasting impact of these technologies on a variety of people, thorough research is necessary. Strong regulatory frameworks will guarantee the efficacy and safety of digital health technologies. To fully utilize such resources for patients' and healthcare practitioners' education is essential. Incorporating gamification components can further encourage increased participation, and extending telehealth and remote monitoring will offer helpful assistance and up-to-date information. Achieving the full potential of digital health technologies will ultimately depend on cooperation between technology designers, medical experts, and consumers. This will lead to greater drug adherence and better medical results.

REFERENCE:

1. Conway CM, Kelechi TJ. Digital health for medication adherence in adult diabetes or hypertension: an integrative review. JMIR Diabetes. 2017 Aug 16; 2(2):e8030. doi.org/10.2196/diabetes.8030

2. Abel C. Mathew, Aneesa M. V, Ashitha Rehman, Dhanush Suresh, T.N.K. Suriyaprakash, Sineesh P. Joy. Assessment of medication adherence patterns and various causes of non-adherence in long term therapies in a tertiary care hospital. Research J. Pharm. and Tech 2020; 13(5): 2420-2426. doi: 10.5958/0974-360X.2020.00434.

3. Hartani NH. The potential of digital health technologies in improving adherence to medication regimens among elderly patients. Archives of Clinical Psychiatry. 2022;49(3). doi.org/10.15761/0101-60830000000429

4. Ridho A, Alfian SD, van Boven JF, Levita J, Yalcin EA, Le L, Alffenaar JW, Hak E, Abdulah R, Pradipta IS. Digital health technologies to improve medication adherence and treatment outcomes in patients with tuberculosis: systematic review of randomized controlled trials. Journal of Medical Internet Research. 2022 Feb 23; 24(2): e33062. Doi.org/10.2196/33062

5. O'Hara DV, Yi TW, Lee VW, Jardine M, Dawson J. Digital health technologies to support medication adherence in chronic kidney disease. Nephrology. 2022 Dec; 27(12): 917-24. https://doi.org/10.1111/nep.14113

6. Dima A, Nabergoj‐Makovec U, van Boven JM. Digital tools and medication adherence. Drug Utilization Research: Methods and Applications. 2024 Sep 9: 419-27. https://doi.org/10.1002/9781119911685.ch41

7. Backes C, Moyano C, Rimaud C, Bienvenu C, Schneider MP. Digital medication adherence support: could healthcare providers recommend mobile health apps? Frontiers in Medical Technology. 2021 Feb 17; 2: 616242. doi.org/10.3389/fmedt.2020.616242

8. Ghozali MT, Forthwengel G. Design, Development, and Usability Testing of a Mobileapp for Medication reminder among patients with Chronic conditions. Research Journal of Pharmacy and Technology. 2024 May 1; 17(5): 2146-54. DOI:10.52711/0974-360X.2024.00339

9. Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. The Journal for Nurse Practitioners. 2021 Feb 1; 17(2): 218-21. https://doi.org/10.1016/j.nurpra.2020.09.013.

10. Husnawati, Elin Yulinah Sukandar, Kusnandar Anggadiredja. Medication Adherence and Characteristics of Hypertensive Patients: A Study in Rural Areas. Research Journal of Pharmacy and Technology. 2022; 15(1): 370-4. doi: 10.52711/0974-360X.2022.0006

11. Marengo LL, Barberato-Filho S. Involvement of human volunteers in the development and evaluation of wearable devices designed to improve medication adherence: a scoping review. Sensors. 2023 Mar 30; 23(7):3597. https://doi.org/10.3390/s23073597

12. Vegesna A, Tran M, Angelaccio M, Arcona S. Remote patient monitoring via non-invasive digital technologies: a systematic review. Telemedicine and e-Health. 2017 Jan 1; 23(1):3-17. DOI: 10.1089/tmj.2016.0051

13. Sally Omar Tawfik Abbas Ebeid, Dixon Thomas, Rajaram Jagdale, Aji Gopakumar, Danial Baker. Impact of Pharmacist Counseling on Treatment Adherence Outcomes of patients undergoing Maintenance Hemodialysis. Research Journal of Pharmacy and Technology. 2023; 16(9): 4384-0. doi: 10.52711/0974-360X.2023.00717

14. Olaboye JA, Maha CC, Kolawole TO, Abdul S. Artificial intelligence in monitoring HIV treatment adherence: A conceptual exploration. https://doi.org/10.53430/ijmru.2024.7.2.0036

15. Sigatapu L, Sundar S, Padmalatha K, Sravya K, Ooha D, Devi PU. Artificial intelligence in healthcare-An overview. Asian Journal of Pharmacy and Technology. 2023; 13(3): 218-22. DOI: 10.52711/2231-5713.2023.00039

16. Vidhani N, Mishra E. Enhancing Work Efficiency through Digital Integration: A Study in Higher Education. Asian Journal of Management. 2024 Sep 30; 15(3): 249-55. DOI: 10.52711/2321-5763.2024.00039

17. Car J, Tan WS, Huang Z, Sloot P, Franklin BD. eHealth in the future of medications management: personalisation, monitoring and adherence. BMC Medicine. 2017 Dec;15:1-9.DOI 10.1186/s12916-017-0838-0

18. Fatima J, Sadiq SM, Ahmed S, Khan R, Uddin MN. Patient medication adherence and the health outcome. Asian Journal of Pharmaceutical Research. 2018; 8(2): 78-82. DOI: 10.5958/2231-5691.2018.00013.8

19. Archana S, Mohan Ram MB. A prospective study on assessment of medication adherence of patients towards antihypertensive medications. Research Journal of Pharmacy and Technology. 2017 Nov 1; 10(11): 3779-82. DOI: 10.5958/0974-360X.2017.00685.0.

Received on 15.10.2024 Revised on 09.01.2025

Accepted on 06.03.2025 Published on 18.04.2025

Available online from April 22, 2025

Asian J. Res. Pharm. Sci. 2025; 15(2):141-146.

DOI: 10.52711/2231-5659.2025.00022

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.