Enhancing Adherence to Prescribed Opioids Using a Mobile-Based App: A Feasibility Study in Non-Cancer Pain

Background: Nonadherence (overutilization and underutilization) to prescribed opioids underlies the current US opioid epidemic/crisis. Methods to measure opioid adherence, including patient recall, pill counts, refill rates, biological monitoring such as urine toxicology, and electronic monitoring such as MEMS Caps, each have limitations or are only proxy measures. While not perfect, apps which both collect instantaneous patient reports of utilization using reminders, and have the potential to encourage appropriate behavior, are gaining popularity as a way to monitor adherence. We were interested to develop such an app to monitor opioid adherence, and report here feasibility of a mobile monitoring and reporting system that would provide an accurate unbiased screening tool to systematically analyze opioid adherence simultaneous to pain measures,

Methods: We developed a mobile-based application, OpPill, for IOS and android platforms. Development and testing consisted of deep mixed methods research on pain behavior and opioid use among SCD patients (n=21) to determine the application content and/or structure. The Application was used by Sickle Cell Disease patients (n=30) at the Virginia commonwealth university health system. The Mobile Applications Rating scale: A New and validated Tool for Assessing the Quality of Health Mobile Apps for engagement, functionality, aesthetics, information quality, subjective quality, relevance and overall impact was administered post usage to evaluate the Application.

Results: A total of 30 patients were tested. Patients were equally divided among males and females, had a high school to graduate level education, with a majority having some college education. The majority of the population found the application to be relevant for their care. When asked to mark all the items they thought the application was designed to do, 37% indicated that it was aimed at improving their physical health, and 37% thought it was designed to help them set goals, while 29.6% and 22.2% said respectively that it helped them feel happy/healthy and reduce negative emotions. In regards to the targeted population, patients where asked if the content was appropriate for sickle cell and the majority said it was well-targeted, with negligible issues (88.8%). Study participants were asked if they would recommend this application to people with sickle cell disease and 100% said they would recommend the application. Patients were also asked to report on the completeness of information within the app, the majority 96% reported on the application's completeness while 4% estimated the information to be minimal or overwhelming. The quality of information as it pertains to sickle cell patients was reported to be relevant (91.7%) while 8.3% found the application to be poorly relevant to sickle cell disease. The application's performance was positively rated at 100% with ease of use positively rated at 91.7%. Most participants (85.7%) found the application to be interesting to use while 74% found it entertaining. All users found the application's navigation to be logical and accurate with consistent and intuitive gestural design.

When asked how many times patients thought they would use the application in the next 12 months, results showed 24% would use it over 50 times, 36% would use it somewhere between 10-50 times and 40% would only use it 3-10 times. Some patients reported that they would pay for the application (24%) while 44% said they might pay and 32% reported that they would not pay for this application. On a scale of 1 to 5 with 1 being the lowest and 5 being the highest, mean engagement, functionality, Aesthetics and information scores were calculated and yielded the following results: mean engagement score: 3.96, mean functionality score: 4.54, mean aesthetics score: 3.96 and mean information score: 3.91.

Conclusions/Future work: We found feasibility of use of a smartphone application specifically targeted to monitor opioid use and behavior in patients with sickle cell disease (SCD)-associated pain. Results are limited in that results are self-reported. Future work should include validation of reported opioid use from the app.