{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:10:52Z","timestamp":1790194252002,"version":"4.1.0"},"reference-count":34,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T00:00:00Z","timestamp":1628467200000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024053","name":"Sydney Local Health District","doi-asserted-by":"crossref","award":["BR17\/1646"],"award-info":[{"award-number":["BR17\/1646"]}],"id":[{"id":"10.13039\/501100024053","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,7,5]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether the Perx app improves medication adherence and clinical outcomes over 12\u2009months compared with standard care in patients requiring polypharmacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Randomised controlled trial with 12-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Outpatient clinics in three tertiary hospitals in Sydney, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Eligible participants were aged 18\u201375 years, with at least one chronic condition, taking \u22653 different medications (oral medications or injections), with smartphone accessibility. Participants were randomised in a 1:1 ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The intervention group used the Perx app that contained customised reminders and gamified interactions to reward verified medication adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was medication adherence over 12\u2009months measured using pill counts. Secondary outcomes included clinical outcomes (haemoglobin A1c (HbA1c), cholesterol, blood glucose, triglycerides, creatinine, thyroid function, blood pressure and weight).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1412 participants screened for eligibility, 124 participants were randomised; 45 in the Perx arm and 40 in the control arm completed the study. The average age was 59.5, 58.9% were women, chronic conditions were cardiovascular disease (78%), type 2 diabetes (75%), obesity (65%) or other endocrine disorders (18%). On average, participants were taking six medications daily. The Perx group had greater improvements in adherence at month 2 (Coef. 8%; 95%\u2009CI 0.01 to 0.15), month 3 (Coef. 7%; 95%\u2009CI 0.00 to 0.14) and month 12 (Coef. 7%; 95%\u2009CI 0.00 to 0.13). The probability of HbA1c \u22646.5% was greater in the Perx group at months 9 and 12 and cholesterol (total and low-density lipoprotein cholesterol) was lower in the Perx group at month 3. The intervention was particularly effective for those with obesity, taking medications for diabetes and taking \u22644 medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides evidence that app-based behavioural change interventions can increase medication adherence and produce longer-term improvements in some clinical outcomes in adults managing multimorbidity. More trials are needed to build the evidence base.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ACTRN12617001285347.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-047041","type":"journal-article","created":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T14:12:57Z","timestamp":1628518377000},"page":"e047041","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":51,"title":["Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-6432","authenticated-orcid":false,"given":"Ang","family":"Li","sequence":"first","affiliation":[{"name":"Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Sydney Health Economics Collaborative, Sydney Local Health District, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Gail","family":"Del Olmo","sequence":"additional","affiliation":[{"name":"Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Sydney Local Health District, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie","family":"Fong","sequence":"additional","affiliation":[{"name":"Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyra","family":"Sim","sequence":"additional","affiliation":[{"name":"Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Sydney Local Health District, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharyn J","family":"Lymer","sequence":"additional","affiliation":[{"name":"Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Cunich","sequence":"additional","affiliation":[{"name":"Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Sydney Health Economics Collaborative, Sydney Local Health District, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Caterson","sequence":"additional","affiliation":[{"name":"Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Sydney Local Health District, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,9]]},"reference":[{"key":"2025121220233482000_11.8.e047041.1","first-page":"e41","article-title":"Cost of medication nonadherence associated with diabetes, hypertension, and dyslipidemia","volume":"4","author":"Nasseh","year":"2012","journal-title":"Am J Pharm Benefits"},{"key":"2025121220233482000_11.8.e047041.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.12.011"},{"key":"2025121220233482000_11.8.e047041.3","doi-asserted-by":"publisher","DOI":"10.1177\/1755738015614038"},{"key":"2025121220233482000_11.8.e047041.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2012.01.008"},{"key":"2025121220233482000_11.8.e047041.5","doi-asserted-by":"crossref","first-page":"71","DOI":"10.5694\/mja2.50244","article-title":"Polypharmacy among older Australians, 2006\u20132017: a population\u2010based study","volume":"211","author":"Page","year":"2019","journal-title":"Medical Journal of Australia"},{"key":"2025121220233482000_11.8.e047041.6","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1001\/jamainternmed.2016.9627","article-title":"Effect of reminder devices on medication adherence: the remind randomized clinical trial","volume":"177","author":"Choudhry","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2025121220233482000_11.8.e047041.7","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2013-002232"},{"key":"2025121220233482000_11.8.e047041.8","doi-asserted-by":"crossref","unstructured":"De Jongh T , Gurol\u2010Urganci I , Vodopivec\u2010Jamsek V . 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