Empowering Patients to Better Manage their Medications: The ‘Smart About Meds’ (SAM) Mobile Application
Over 3 million hospitalizations and 17 million emergency department visits occur each year in Canada, a significant proportion of which are medication-related and preventable. Studies have shown that many such events are the result of prescribing or dispensing errors, incomplete drug information, and the underuse or overuse of medications. In fact, our previous study showed that 55% of patients discharged from hospital did not adhere to at least one of the changes made to their medication regimen at discharge, which subsequently increased their risk of adverse events. Analyses of patient interview data suggest that unclear communication with patients about medication changes may be driving non-adherence, as might difficulties in managing complex drug regimen information and dosing schedules. To address this apparent need for patient support mechanisms that reduce medication non-adherence, we developed the SAM mobile application, which is aimed at improving medication management following hospital discharge. The app provides patients and their caregivers with a continuously updated medication list, pill images, drug information, medication reviews by other patients, a side effect checker, alerts if they do not follow planned therapy, and the ability to connect with hospital pharmacists when needed. We plan to conduct a pilot study to assess the usability of the app and, at a later stage, a larger clinical trial to evaluate its effectiveness in improving adherence and reducing the occurrence of adverse events.
Funded By: Économie et l’Innovation Québec
Q1. Where does my medication data come from?
The SAM app displays a list of medications prescribed to you at hospital discharge, as well as the medications you purchase after being discharged home from the hospital. Medications prescribed to you at discharge are obtained from your hospital medical record and manually entered into our databases by members of our research team. Medications dispensed to you following hospital discharge are retrieved via a real-time link to the provincial health insurer and are matched to your prescribed medications.
Q2. Where does information on medications, side effects and interactions come from?
Information on medications, side effects and drug-drug interactions are obtained from Vigilance Santé, a Quebec company that develops drug treatment software and databases that are used in over 4,500 pharmacies and by over 20,000 health professionals. You can learn more about the company here: https://www.vigilance.ca/home
Q3. Where does information on potentially inappropriate medications come from?
Potentially inappropriate medications are flagged based on the Beers Criteria, published by the American Geriatrics Society. The Beers Criteria is an evidence-based list that includes medications that are inappropriate for older adults. Our research and development team developed an algorithm based on the Beers Criteria to identify potentially inappropriate medications in your list. You can learn more about the Beers Criteria here: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.15767
Q4. How often is my medication list in SAM updated?
Your medication list is updated daily. If you buy a medication on Monday, you can expect to see it in your SAM medication list on Tuesday. In rare cases, in may take up to 3 days for a medication to appear in your SAM list.
Q5. How long after sending a message to the pharmacist can I expect a response?
SAM pharmacists typically check for messages from users 3 times a day, between 9 am and 5 pm, Monday to Friday. You can expect a response to your question during those times.
Q6. Why are my medications listed twice, sometimes under different names?
SAM shows you the medications you have been prescribed, as they appear on your hospital discharge prescription. The app also shows you the medications you have purchased from your community pharmacy. We match your purchased medications to those on your prescription. So, for every prescribed medication that you have bought, the name of the purchased medication will appear under the prescribed medication. Prescribed and purchased medication names may be the same or they may differ. This is because the same medication can have multiple names depending on its brand. Your physician, for example, may have prescribed “Ibuprofen”, whereas you might have bought the brand “Advil”. In this situation, in SAM, “Ibuprofen” will be listed as the prescribed medication name, with “Advil” listed under it as the purchased medication name.
Q7. Some of the medications I have purchased do not appear in my medication list. Why is that?
We obtain information on the medications you purchase from the provincial health insurer (RAMQ – Régie de l’assurance maladie du Québec). The RAMQ holds information only on those medications for which it has reimbursed you. This includes all medications that the RAMQ covers under its prescription drug insurance policy. If you have purchased medications that are not covered by the RAMQ, these will not appear in your medication list because we have not received information on them.
Q8. SAM is alerting me that I have not bought one of my prescribed medications. I did buy this medication though. Why am I still getting an alert?
As mentioned in Q4, we do not receive information on medications you have bought which the RAMQ does not cover as part of its prescription drug insurance policy. In such cases, you could receive a “false positive” alert in SAM reminding you to buy a medication you have actually already bought. In such cases, you can ignore the alert and explain in the alert resolution box that you have already bought the medication.
Q9. Once I purchase a medication, how long will it be listed in SAM?
The SAM app displays a list of medications prescribed to you at hospital discharge, as well as the medications you purchase after being discharged home from the hospital. Medications prescribed to you at discharge are obtained from your hospital medical record and manually entered into our databases by members of our research team. Medications dispensed to you following hospital discharge are retrieved via a real-time link to the provincial health insurer and are matched to your prescribed medications.
Q10. What do the percentages listed next to medication side effects mean?
In clinical trials of medications, scientists compare the occurrence of side effects between patients who take the medication and those who do not take the medication. The side effect percentages in SAM refer to the percentage of people who took the medication during the trial who experienced the symptom. For example, if 100 people in the trial took the medication and 10 of those experienced the symptom, the percentage would be 10%.
Q11. Why don’t all medication side effects have a percentage listed next to them?
We obtain information on side effects from Vigilance Santé, a Quebec vendor of drug information. The information we obtain includes the percentage of people in clinical trials who experienced a side effect. Sometimes, this information is missing from the data provided by the vendor. In these cases, we do not list a percentage next to a side effect. This does not mean that the side effect is unimportant or does not occur, but rather that we don’t have the relevant information about the percentage.
Q12. Why aren’t all my medications automatically scheduled in the Weekly Schedule?
We use dosage instructions from your prescription to automatically schedule medications in the weekly schedule. Sometimes, these dosage instructions are in a structured, easy-to-interpret format, such as “1 tablet every morning”. In these cases, our software can easily interpret the dosage instructions and automatically enters your medication into the schedule accordingly. In other cases, dosage instructions are not as straightforward. In such cases, our software cannot easily interpret the dosage instructions and therefore does not enter the medications into the schedule. You may, however, manually enter a medication in the schedule by indicating the days and times you take the medication.
Q13. My medication was automatically scheduled for a specific time. Can I change this time?
Yes. The weekly schedule provides you the flexibility to change medication times to suit your preferences. It is important to note that medications are automatically scheduled based on dosage instructions in your prescription. Our software has default times for different dosage instructions. For example, SAM automatically sets medications that should be taken in the morning to a default of “9 AM”. You can change this to another time, such as “8 AM”. When changing a medication’s time, it is important that you still adhere to the dosage instructions. If something is meant to be taken in the morning, we advise you to speak to your pharmacist or physician before changing the time to the evening, “9 PM” for example.
Q14. Why did I get a warning message when I changed the time of my medication in the Medication Schedule?
It is important that you adhere to the dosage instructions in your prescription. If you change the timing of a medication in the Medication Schedule in a way that is significantly different from your dosage instructions, SAM will generate a warning to ensure that you are aware of the discrepancy. This could happen when your prescription dictates that you take a medication in the morning, for example, but you schedule the medication for the evening. It could also happen when your prescription dictates that you take a medication once a day, for example, but you schedule it for twice a day in the weekly schedule. You should always speak to your pharmacist or physician before changing the schedule or dose of your medications.
Was your question not answered?
You can email us your questions at info@sam.mcgill.ca or call us at 514-886-3313 between 9 am and 5 pm, Monday to Friday.
PRIVACY POLICY – SMART ABOUT MEDS (SAM) MOBILE APP
Your privacy and the protection of your personal information are of the utmost importance to us. We have taken considerable steps, outlined in this policy, to ensure the confidentiality, security, and integrity of your personal information. We encourage you to carefully review the information below regarding the privacy policy of the SAM mobile app.
This policy outlines the commitments we make concerning the privacy, security, and confidentiality of your personal information. We may update this policy from time to time, so we encourage you to review the policy periodically. Any changes made to the policy will be effective immediately as of the posting of the revised policy. Please do not use the SAM app if you do not agree to the terms of this privacy policy.
HOW WE RECEIVE THE DATA DISPLAYED IN SAM
You have been granted access to the SAM app because you provided written consent to participate in the research study titled “Smart About Meds (SAM): A Randomized Controlled Trial of a Mobile App to Enhance Adherence to Medication Changes Following Discharge from Hospital”. This study has received funding from the Canadian Institutes of Health Research (CIHR) and has been granted approval by the Research Ethics Board (REB) of the McGill University Health Centre (MUHC).
By consenting to participate in the SAM research study, you consented to allow us to retrieve information about the medications prescribed to you at hospital discharge, as well as the medications you purchase after being discharged home from hospital. Medications prescribed to you at discharge are obtained from your hospital medical record and manually entered into our databases by members of our research team. Medications dispensed to you following hospital discharge are retrieved via a real-time link to the provincial health insurer. Both your prescribed and dispensed medication information are displayed to you in the SAM app.
THE DATA WE COLLECT VIA THE SAM APP
HOW WE STORE DATA DISPLAYED IN SAM AND COLLECTED VIA SAM
All data displayed in SAM and collected from SAM are stored on secure servers on the McGill University network. The network is a highly restricted environment with no access to the internet. You access the SAM app via a remote proxy server which acts as a mediator from the internet to the McGill server. A robust firewall system restricts access to and from the server to the internet. There is also a campus-wide antivirus system that monitors traffic and keeps our systems safe. User access to the server is logged and is highly restricted to support staff.
WITH WHOM WE SHARE YOUR PERSONAL INFORMATION
No data or information from the app will be accessible by third parties. Only you, your chosen caregiver (if any), the hospital and community pharmacists providing support through the app, and the SAM research team will have access to data in the SAM app. Furthermore, the SAM app does not access any other apps on your device, nor does it access any personal information besides that which you provided during consent or has been obtained from your hospital medical record or the provincial health insurer.