Feasibility, fidelity and initial effects of an app-based service for short-term antibiotic therapy: A pilot study in a primary care setting

Short-term antibiotic treatments show medication non-adherence rates around 40%, limiting therapy success and increasing risk for recurring infections. Smartphone applications offer simple solutions to support patients' medication adherence. To evaluate service and trial feasibility of a smartphone-based adherence support delivered by community pharmacists and to explore initial effects. We conducted a cluster-randomized pilot trial. Community pharmacies recruited eligible patients with newly prescribed amoxicillin/clavulanic acid therapy when dispensing the prescription. Participants used an app to confirm medication intakes. The intervention group received intake reminders and text messages. We evaluated feasibility and fidelity based on data quality, participant satisfaction, and extent to which service activities were delivered as planned. For exploratory analyses, we used the Mann-Whitney U test, and calculated effect sizes. Fifty-seven community pharmacies and 34 patients participated in the study (17 per group). Twenty-nine participants (85%) fully completed the study. Twenty-one participants (62%) used and returned the symptom diary. For 30 participants (88%), the app was installed correctly and twenty-five (83%) participants consistently used the app. We observed small, non-significant effects for taking adherence ( r = 0.158) and timing adherence ( r = 0.147), and small-medium ( r = 0.294) for dosing adherence. This study demonstrated feasibility and fidelity of a smartphone-based therapy support in the community pharmacy setting. Trends suggest a potential improvement in adherence rates through smartphone reminders and text messages. These findings highlight the need for a fully powered trial. • Community pharmacies can deliver high-quality app-based adherence support. • The majority of patients demonstrated consistent engagement with the app. • Apps show potential to support antibiotic therapies; larger studies are necessary. • Targeted recruitment strategies are crucial for future adherence intervention studies.