Text message reminders do not help improve long-term medication adherence

A new study was published today in JAMA revealed that text message reminders to patients who delay refilling their medications have not helped improve the frequency with which they refill their medications over a year.

The study enrolled over 9,000 patients in a randomized, pragmatic clinical trial and included representatives of a diverse population of subgroups, including women, Hispanic ethnicity and Spanish-speaking patients, all groups that may be traditionally underrepresented in clinical trials.

“There are many studies focused on using technology to improve health behaviors. However, it is unclear and little researched whether SMS reminders are effective over time as they have become a common practice in healthcare settings. “That’s one thing.” One of the reasons we wanted to focus in this study on SMS reminders to refill medications, which we hoped would also reduce serious health problems,” said lead author Michael Ho, MD, associate professor in the Department of Medicine and Cardiology at the University of Colorado School of Medicine at the University of Colorado Anschutz Medical Campus.

Researchers compared different types of text messaging strategies to usual care to improve medication refill adherence for chronic cardiovascular medications. If patients had a refill gap of more than seven days, messages were delivered and sent in either English or Spanish depending on the patient’s language preference.

“An important factor in our research was the inclusion of representatives from diverse backgrounds, as different cultures and experiences can shape preferences for communication methods and lead to different technology behaviors,” said lead author Sheana Bull, PhD, MPH, professor emeritus and advisor to the mHealth Impact Laboratory at the Colorado School of Public Health on the CU Anschutz Medical Campus. The mHealth Impact Laboratory is an incubator for innovative health technology and disease management initiatives.

The research found that adherence to refills improved by five percentage points in the first three months and the median length of initial gaps was reduced by about five days, meaning patients were kept five days longer on their medication. However, SMS reminders were not effective in improving adherence to refills at 12 months, regardless of the type of message: generic text messages, messages that used persuasive communication strategies called “behavioral nudges” or “behavioral nudges” plus a chatbot. This was the same for all genders and races and there was no difference between the different texting methods.

“Chronic diseases are on the rise and controlling these diseases often requires long-term use of medication by patients. It is important to find strategies to help patients take their medications regularly to prevent these conditions from worsening. Our study shows that adherence to chronic cardiovascular medications has been low over 12 months, and therefore we need to test new strategies to improve this, especially as more people develop chronic diseases,” adds Ho.

Next, researchers will examine whether more advanced digital technologies that integrate machine learning and artificial intelligence can improve medication refill behavior in the longer term.

This research was conducted by a team at the CU Anschutz Medical Campus that included faculty from the CU School of Medicine, the Skaggs School of Pharmacy and Pharmaceutical Sciences, and the Colorado School of Public Health.