Can text message reminders enhance medication adherence and improve clinical outcomes in patients who are nonadherent to cardiovascular medications?
Poor medication adherence is a widespread issue, and while text messaging is increasingly employed to influence patient behavior, it is often not rigorously evaluated. A new study seeks to compare various text messaging strategies against standard care to determine their effectiveness in improving medication refill adherence among patients who are nonadherent to cardiovascular medications.
A study reports that text message reminders for patients who delayed refilling their medications did not significantly improve refill consistency for a year.
The randomized pragmatic clinical trial included over 9,000 participants, representing a diverse population across subgroups, such as women, Hispanic individuals, and Spanish-speaking patients—groups often underrepresented in clinical research.
First author Michael Ho, MD, professor adjoint in the department of medicine and cardiology at the University of Colorado School of Medicine on the University of Colorado Anschutz Medical Campus, said, “There are a lot of studies that focus on using technology to improve healthcare behaviors. However, it’s unclear whether text message reminders are effective for a sustained period, given they have become a commonly used practice in healthcare settings.”
“That’s one of the reasons we wanted to focus on text message reminders for refilling medication in this study, which we were hoping would also decrease serious health issues.”
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The researchers evaluated the effectiveness of various text messaging strategies compared to usual care in improving medication refill adherence for chronic cardiovascular medications. Messages were sent when patients had a refill gap exceeding seven days and were delivered in either English or Spanish, depending on the patient’s language preference.
Senior author Sheana Bull, PhD, MPH, professor emerita and advisor to the mHealth Impact Laboratory at the Colorado School of Public Health on the CU Anschutz Medical Campus said, “An important factor of our research was to include representation from a range of backgrounds since different cultures and experiences can shape preferences for communication methods and result in varying technology behaviors.”
The study found that text message reminders improved medication refill adherence by five percentage points during the first three months and reduced the median length of initial refill gaps by about five days, providing patients additional days of medication supply.
However, regardless of the messaging approach, the reminders did not enhance refill adherence at 12 months. This included generic messages, those employing behavioral nudges, or behavioral nudges combined with a chatbot. The results were consistent across all genders, races, and text message methods, with no significant differences.
First author Michael Ho, MD, professor adjoint in the department of medicine and cardiology at the University of Colorado School of Medicine on the University of Colorado Anschutz Medical Campus, said, “Chronic medical conditions are increasing, and controlling these conditions often requires patients to take medications long term. It’s important to identify strategies to help patients take their medications regularly to prevent these medical conditions from worsening.”
“Our study shows adherence to chronic cardiovascular medications was low over 12 months, and therefore, we need to test new strategies to improve this, especially as more people develop chronic medical conditions.”
The researchers plan to explore whether advanced digital technologies, such as those incorporating machine learning and artificial intelligence, can more effectively promote long-term improvements in medication refill behaviors.
Journal Reference:
- P. Michael Ho et al. Personalized Patient Data and Behavioral Nudges to Improve Adherence to Chronic Cardiovascular Medications. JAMA. doi: 10.1001/jama.2024.21739