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.

http://archinte.jamanetwork.com/article.aspx?articleid=2484905

Text Message Communication with Patients

In a single-blind randomized, patients with hypertension in South Africa were divided into three different groups of care. The first group continued the usual way with routine doctor’s appointments. The second group was involved in an information only daily text messaging system and finally, the last group was involved in an interactive text messaging system. The goal of the study was to see how increased interaction with the patient could impact systolic blood pressure over the span of twelve months. The hopes of increased interaction through the text messaging system were that they would increase the adherence and that cognitive thought about their disease state daily would ensure better decision making in their lifestyle choices. The study concluded that there was a greater decrease in the systolic blood pressure of those individuals whom received daily text messages and then only a slight decrease in the individuals with the interactive text messaging.

In the medical world today, it is crucial to be able to keep up with the technology when interacting with patients. Being able to reach patients efficiently, as according to the study, is necessary in maintaining patient adherence. Additionally, being able to be readily available to patients will enable the patient to get questions easily answered and clear up any confusion with medications or therapy regiments. Keeping up with the technology and creating new ways to reach patients is important to maintain the contact with patients throughout the term of a year in between doctor’s visits.

Bobrow, K, Farmer, AJ, et al. Mobile Phone Text Messages to Support Treatment Adherence in Adults with High Blood Pressure (StAR): A Single-Blind Randomized Trial. Circulation Journal. (published 14 January 2016)

CirculationAHA.115.017530

Borrow, K, Farmer, AJ, et al. Mobile Phone Text Messaging to Support Treatment Adherence in Adults with High Blood Pressure. Circulation AHA. Published online January 14, 2016.