Studying the Effect of Text Messaging on Medication Adherence in Chronic Disease

A recent article reviewed the effectiveness of text messages as a tool for medication adherence for adult patients with chronic diseases. The reviewers recognized that although apps can be very helpful for those with smart phones, unfortunately many of those in the older population with chronic diseases do not have the most up-to-date technology. In the past, special pagers or devices with reminders were proposed to aid in adherence but due to low availability and an uncertain relation to routine care, they have been relatively ineffective as a reliable assistant.

As we have learned, adherence is clearly a very large issue, costing the United States almost $1 billion each year and $2000 for each patient in extra physician visits alone. Not only is cost a major factor, but the health of the patient is obviously a huge concern as well. Many patients with chronic disease states will become nonadherent to their therapy because they are not experiencing a noticeable difference in their health. Unfortunately this could cause their disease to worsen and require the need for additional medications.

The authors of the article conducted a literature search to find randomized clinical trials involving adults over the age of eighteen with a chronic disease that received a text message to promote adherence. Studies were excluded if their primary intervention was not a text message or if the study involved psychiatric, military, or institutionalized patients to avoid other possible controls on adherence. Sixteen randomized clinical trials were identified that included over 2,500 patients with a mean participant age of thirty-nine, a median intervention duration of 12 weeks, and including disease states of HIV, cardiovascular disease, asthma, allergic rhinitis, diabetes, and epilepsy. The type and frequency of text messages varied among the studies, with some texting at fixed time intervals and others sending only if the patient did not open their medication dispenser. Some messages included personalization with the medication name and dosage while others were generic.

It was concluded that text messages did in fact increase adherence and the study participants were moderately to highly satisfied with the assistance. The researchers did emphasize however that further studies with longer time periods and more objective measures of the outcome are necessary to come to significant conclusions.

What personalization of a text message do you think would be most effective, or should it change based on the patient’s beliefs, social activities, age, etc?

Reference: Thakkar J, Kurup R, Laba T, et al. Mobile telephone text messaging for medication adherence in chronic disease. Jama Intern Med. Published online February 1, 2016.

3 thoughts on “Studying the Effect of Text Messaging on Medication Adherence in Chronic Disease”

  1. I think this is a terrific solution for the technology natives that experience problems with adherence, although not one without its own set of unique barriers. I would think that a high detail would have to be included for patients to understand their text reminders, particularly for patients with numerous prescriptions for more than one chronic disease. If you could find a way to incorporate it with their pharmacy or health care provider, and include counseling points in the reminders if doses are missed frequently you may decrease some of the problems associated with non-adherence. Also, including input from the patients’ pharmacist/provider would help identify patients with issues taking their medications consistently. However, I think that age restrictions are necessary for this proposal. It has been my experience that many elderly Americans resist the incorporation of technology in their lives. In particular, I have seen numerous examples of resistance to smart phones not because they do not understand the technology, but also tactile barriers exist for using such a finely tuned touch screen. Otherwise, I think this is an excellent idea to hopefully lower the cost fallout seen in non-adherence issues.

  2. I think this is a great method of increasing medication adherence. In today’s world, many people constantly have their cell phones at their side, and getting a text message to remind them to take their medication seems to be a step in the right direction to solve the problem of non-adherence. I agree with the previous comment that this may not be an effective method for certain members of the older adult population. However, I know that there are plenty of older adults who are learning to utilize technology. Even if all older adults aren’t able or willing to utilize this medication adherence tool, it may still be beneficial for some of the population. For those people, it could make a world of a difference in their treatment. Additionally, middle-aged adults who are currently using technology will most likely continue to do so into their older years. Therefore, future older adults may benefit more from this adherence method. Longitudinally, I believe this method of promoting adherence could affect many people and consequently affect the way in which they take their medication.

  3. I think this is a fantastic finding and a great breakthrough for the future of pharmacy. One issue that may arise later though could be who will pay for those messages? There are companies that do text messages and charge the user for receiving them and this would make it more unlikely that patient would use this resource. However, would it be the pharmacy’s responsibility to cover that cost? The insurance company? The mobile phone company? These questions should have relatively easy solutions but they nonetheless could become a issue should this solution gain momentum.

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