Remembering to take the right medicine at the right time is a common problem, especially for older patients with multiple health conditions. To address this challenge, Adjunct Associate Professor Tan Ngiap Chuan, who is also the Director of Research at SingHealth Polyclinics, and his team are turning to technology. He shares more about his research project and the challenges of adapting technology to meet the needs of older people.

How common is it for patients not to take their medication?

Unfortunately, it’s a very common issue. When we studied how often 1,017 SingHealth Polyclinic patients aged 21 years and above who took their medication regularly, only 43% of patients were compliant for diabetes medication, 55% for high blood pressure and 36% for high cholesterol. So the majority of our patients with these conditions are still at high risk of life-threatening and disabling conditions such as stroke and kidney disease. There are many reasons why patients don’t take their medication. For example, they think they don’t need to because they feel fine, fear of side-effects and especially forgetfulness. Skipping medication is particularly common in older patients with multiple health conditions because they often need to take more than four pills every day, sometimes at different timings or frequency.

Why did you decide to develop an app and what challenges did you need to overcome? 

Our older patients are not as IT-savvy as their children or grandchildren, but many of them own a smart phone. If you take a look around the polyclinic waiting areas, you will see them checking their messages or playing games on their phones. With this key observation, we decided to do a pilot project with 30 patients aged above 50 years and their caregivers to see if an ‘elder-friendly’ medication reminder phone application could work to help improve the adherence to their diabetes medicine.

Many of our patients suffer from similar chronic health conditions but their personal circumstances are unique. This affects the way in which they manage their health issues. Some are highly educated who prefer instructions in English, while others are illiterate and can only speak dialect. Some patients have strong family support while others live alone. Therefore, we needed to find a practical solution that could be customised to meet such a diverse range of needs. 

How did you design the app to be ‘elder-friendly’ and how does it work?

We needed a simple app that could be used by patients who cannot read and who speak many different languages and dialects. So we worked with Nanyang Polytechnic to develop one with pictograms instead of text buttons to make it more intuitive and user friendly. A key feature is the timed reminder function which can be set up as an alarm or a pre-recorded voice message, so that family members or staff can record specific messages in a dialect or language that the patient understands, such as “Selamat pagi bapa! Sekarang pukul lapan pagi. Sila ambil ubat biji merah,” which is Malay for “Good morning, father! It’s now 8am. Please take the red pill.” 

Once the patient has taken the pill, he presses a button on his phone and this sends a message to his caregiver’s phone to alert her that he has taken the medication. If the patient doesn’t activate the button after taking his pill, an alert will be sent to his caregiver’s phone so she can call her loved one to remind him and to make sure he is okay. This feature was receptive by working family members who felt it was an unobtrusive way to check if their parents were taking their medication.     

What is the next step for this research? 

So far, we are very encouraged that only one participant has dropped out of the pilot. Interestingly, a number of them plan to continue using it even though the pilot is over. 

Now that we have the proof-of-concept of the app, we want to scale up and conduct a larger research project involving about 300 patients and include medication for more types of conditions. With more participants, we can then measure how effective the app is at improving medication adherence and study its impact on patients’ health status such as their blood pressure and diabetic control, and complication rates. My team and I strongly believe that every step we take in helping older patients improve the way they manage their health conditions will lead to a reduction of their risk of complications. Ultimately, this will help older patients age well during their golden years. 

This research project is featured in conjunction with the SingHealth Duke-NUS Gala Dinner 2019, a biennial signature fundraising event in support of medical research and education. To make a gift towards Family Medicine ACP, please call Angeline Tan, 6350-7549 or Winnie Seah, 6350-7605.