Adherence means taking your medicines the way they were prescribed: the right dose, at the right time, every day for as long as the course runs. A medication adherence app is useful if it narrows the gap between meaning to do that and actually doing it on an evening when dinner ran late and the phone was on Silent. Most of what makes that work is a handful of unexciting features.
What adherence means
In a review in Mayo Clinic Proceedings, Marie Brown and Jennifer Bussell define adherence as "the extent to which a person's behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a health care provider." For medicines that comes down to three things:
- The right dose: one tablet when the label says one. Not half, and not a second one because you can't remember whether you took the first.
- At the right time. For many medicines there is some leeway. For others the timing is tight, and the label or your pharmacist will tell you which kind yours is.
- Every day, for the whole course. Stopping early, or taking a daily tablet four days out of seven, isn't the treatment that was prescribed.
An app can help with the first two by reminding you and letting you record what you took. It helps with the third by making the first two easy enough that you keep doing them.
Why people miss doses
Most missed doses come down to an ordinary busy day, or a reminder that never reached you. Why people miss medication doses goes through the common reasons: a dose with nothing in the day to anchor it, a reminder you didn't see, not being sure whether you already took it, a schedule that doesn't fit your day, running out, side effects or cost, and too many medicines. Each one has a different fix.
It happens a lot. A 2017 CDC report states: "Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration" (CDC, MMWR, 2017). Brown and Bussell write: "Among patients with chronic illness, approximately 50% do not take medications as prescribed" (Mayo Clinic Proceedings, 2011).
Which medication adherence app features actually help
1. Reminders that sound on Silent
Standard iOS notifications are silenced by Silent mode and by Focus, which is fine for most apps and wrong for medication. iOS has a separate kind of notification, Critical Alerts, that can sound through both. It needs a separate permission that you grant yourself.
If an app's reminders can't use Critical Alerts, they stay silent whenever your phone is, so check this first. In Doz, Critical Alerts are part of Doz Pro. On the free version, reminders are standard notifications that follow your Silent and Focus settings.
2. A follow-up for doses you haven't logged
A second reminder catches the doses the first one missed. The pattern that works is a reminder at the dose time, then another a little later only if the dose is still not logged. The phone doesn't buzz all afternoon, and a missed reminder gets a second try.
In Doz this is a follow-up nudge, sent 5 to 60 minutes later (you choose) and only if the dose is still unlogged. It is part of Doz Pro.
3. A log you can look back at
Memory won't reliably tell you whether you took Tuesday's dose. A log of what was due, what you took and when answers it. It also gives you something concrete to show a pharmacist or doctor.
Record the doses you actually took. A record that shows a missed dose is more useful than one that assumes you took everything.
4. An adherence rate you can see
A log is easier to read as a number that answers "how am I doing on this medicine?", and the app should work it out for you. In Doz the free version shows the last seven days on the Progress screen, and asking Siri "How am I doing in Doz" is free. Full history, and adherence and on-time rates for each medicine and prescription, are part of Doz Pro. To work the number out from your own records, or to check what an app shows, use the adherence rate calculator.
5. A warning before you run out
Running out means missed doses. With one prescription you notice the bottle getting light. With several, each on its own refill cycle, you won't. You need an app that counts what's left and warns you while there are still pills in the bottle, so you have a few days to arrange the next supply.
An app that doesn't record how much you have can't do this, so check before you spend an hour entering everything. Doz counts each medicine down as you log doses and shows a low-stock warning in the app once the count reaches a level you choose. Doz doesn't send a separate notification for it. Stock counting is in the free version.
6. Fast logging and room for several medicines
Logging a dose should take a couple of seconds. With Doz Pro you can log by voice, for example "Take my metformin in Doz". Apple requires the app's name in every Siri phrase, so the phrase has to end with "in Doz". Doz Pro also lets you mark a dose taken or skipped straight from the reminder.
The app also has to handle several prescriptions without turning into a long list of pills. Doz groups each medicine under the prescription it came from, which keeps the list readable as it grows. The free version covers up to 4 medicines and 1 prescription, and Doz Pro removes both limits. There is more on this in reminders when you take several medicines.
The features side by side
| Feature | Why it matters for adherence | In Doz |
|---|---|---|
| Scheduled reminders | Tie each dose to a time or a meal | Free |
| Reminders that sound on Silent (Critical Alerts) | A reminder that never sounds can't help | Doz Pro |
| Follow-up for unlogged doses | A second try when the first reminder is missed | Doz Pro |
| Dose log | A record instead of a guess | Free: last 7 days. Full history: Doz Pro |
| Adherence rate | Answers "how am I doing?" | Free: last 7 days. Per medicine and prescription: Doz Pro |
| Low-stock warning | You reorder before the bottle is empty | Free |
| Logging with Siri or from the reminder | Fewer steps, fewer forgotten logs | Doz Pro |
| Several medicines grouped by prescription | The list stays readable as it grows | Free: up to 4 medicines, 1 prescription. More: Doz Pro |
| No account, data on your device | Fewer places your medication list is stored | Free |
How to measure your own adherence
You only need one division: doses you actually took, divided by doses that were due, over the same period. A month is a sensible period to use.
Say you take one tablet a day for 30 days and miss 4. That's 26 taken out of 30 due, or 86.7%. The adherence rate calculator does this sum, and it also tells you how many misses still clear a target you set.
Two things to keep in mind about the number:
- The trend matters more than any one figure. What helps is seeing which doses, days or weeks slip, and whether a fix you tried made a difference.
- The number doesn't explain itself. A low rate can mean the schedule doesn't fit your life, the side effects are hard, the cost is a strain, or something else. It shows you where to look, and your doctor or pharmacist can help with what to do about it.
How to choose a medication adherence app
Check these in the App Store listing before you commit:
- Can reminders sound when the phone is on Silent? Look for Critical Alerts support, and whether it's free or paid.
- Can you log a dose in a couple of seconds, from the reminder, a widget or by voice?
- Does it show an adherence rate, and over what period?
- Does it count your supply and warn you before you run out?
- Can it handle your actual instructions, such as doses tied to meals, cycles like 21 days on and 7 off, or several medicines on one prescription?
- Does it need an account? That's one more password, and one more place your medication list is stored.
- Where is the data kept? On your phone only, or on the company's servers?
For reference, here is Doz against that list. It groups medicines by prescription, handles meal-based doses and cycles, counts stock and warns you before you run out, and needs no account. It doesn't collect your name, email or phone number. Your data stays on your device. If you turn on iCloud sync, it moves between your own devices through Apple's private CloudKit database, which Apple encrypts end to end and the developer cannot access. Critical Alerts, follow-up nudges, logging by voice or from the reminder, full history, and more than 4 medicines or 1 prescription are part of Doz Pro. The privacy policy takes about a minute to read.
What a medication adherence app cannot do
Know the limits before you rely on one.
- It doesn't give medical advice. An app can tell you what you were prescribed and when. It can't tell you whether two of your medicines interact, whether a dose should change, or whether a side effect means you should switch. Ask your pharmacist or prescriber.
- It doesn't take the dose for you. The reminder tells you it's time, and the rest is up to you.
- It only knows what you tell it. A medicine you haven't entered, a dose you took but didn't log, or a change your doctor made at an appointment won't show up in the app. The record is only as good as what goes into it.
Do not stop or change a prescribed medicine without talking to your doctor or pharmacist first.
Frequently asked questions
What is a medication adherence app?
It's an app that helps you take your medicines the way they were prescribed: the right dose, at the right time, every day for the whole course. That usually means reliable reminders, a quick way to log what you took, a view of how you're doing, and a warning before you run out. Reminders do the daily work; the log and the stock count are what keep it useful over months.
Is a medication adherence app the same as a medication compliance app or a medications tracker?
Mostly, yes. People use the names for the same kind of app. "Compliance" is the older word. Brown and Bussell note that "adherence presumes the patient's agreement with the recommendations, whereas compliance implies patient passivity." A "medications tracker" is usually the same kind of app with more focus on the record of what you took and when. The useful features are almost the same.
Can an adherence app help if I only take one medicine?
For reminders alone, a phone alarm may be enough. An app becomes worth it when you add a second medicine, a course with an end date, a supply you need to reorder in time, or doses tied to meals or cycles rather than a fixed time.
Will the reminders sound if my phone is on Silent?
Only if the app supports Critical Alerts and you've granted that permission. Ordinary notifications are silenced by Silent mode and Focus. In Doz, Critical Alerts are part of Doz Pro. On the free version, reminders follow your iPhone's Silent and Focus settings.
How do I work out my adherence rate?
Divide the doses you took by the doses that were due over the same period, and multiply by 100. Missing 4 of 30 once-a-day doses gives 86.7%. The adherence rate calculator does the sum for you.
Do I need an account or a cloud service to use one?
Not with every app. Some need an account and keep your list on their servers. Doz needs no account and keeps your data on your device. If you turn on iCloud sync, your data moves between your own devices through Apple's private CloudKit database, which the developer cannot access.
Where to start
Start with the reminder: make sure it can reach you on a silenced phone. Then check that logging takes seconds and that the app counts your supply, because those two are what make the adherence number at the end of the month worth reading.
Doz is a free download on the App Store: medicines grouped by prescription, a log with your adherence rate, low-stock warnings before you run out, and no account to create.
Sources
- CDC: CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management — Innovations and Opportunities (MMWR, 2017)
- Brown MT, Bussell JK. Medication Adherence: WHO Cares? Mayo Clinic Proceedings, 2011
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