Text Messages Help Boost Short-Term Medication Adherence

Steven Fox

April 26, 2012

April 26, 2012 — Sending patients electronic reminders to take their medications can help boost adherence, at least in the short term, according to results from a new systematic review focusing on patients with chronic diseases. But it remains unclear how long the effects of such interventions last.

The review was conducted by Marcia Vervloet, MSc, from the Netherlands Institute for Health Services Research, Utrecht, and colleagues. It was published online April 25 in the Journal of the American Medical Informatics Association.

The authors note that although previous studies have evaluated whether electronic reminders can improve adherence, most have concentrated on specific populations, such as patients with glaucoma, cardiovascular disease, diabetes, or HIV.

In addition, they say, most evaluated interventions that were complex, time-consuming, labor-intensive, and costly. And most, they say, turned out to be not very effective.

But electronic reminders, once they are set up, are transmitted automatically to patients at the appropriate time and require no day-to-day intervention from healthcare providers.

Types of electronic reminders include text messages sent automatically to patients' mobile phones with a short message service (SMS), electronic reminder devices (ERD) that give patients an audible or visual reminder at a predetermined time, or text messages sent via pagers.

"To our knowledge, no review has been conducted that systematically studied the effects of specifically electronic reminding (eg, via SMS, ERD, pager/beeper systems) on patients' adherence to a range of long-term medication," they write.

To that end, the researchers evaluated results from 13 trials that fit inclusion criteria: 4 focused on texting using SMS, 7 on audiovisual reminders from ERDs, and 2 on messages delivered via pagers.

Five of the studies evaluated included patients taking antiretroviral drugs, 3 included patients taking antihypertensive agents, 2 included patients taking medications to manage asthma, 2 included patients with glaucoma, and 1 included women taking oral contraceptives.

All the studies focused on adults, with the exception of 1 that included adolescents. Duration of medication varied from study to study and also within individual studies.

To assess the effectiveness of the various types of reminders, the studies used electronic monitoring (registering the date and time of every medication intake), combined electronic monitoring with self-report, bottle weight, or self-reporting.

As to overall results, the researchers say that 9 of the studies indicated that the electronic reminders helped patients adhere to their medication regimens. In 8 of the 9 the improvement was statistically significant.

Reminders sent via text messages were especially effective, the researchers say.

The researchers emphasized an important caveat, however: Only 3 of the 13 studies monitored the effect of the reminders for more than 6 months. And in only 1 of those 3 studies did the improvement in adherence attain statistical significance.

"Future studies should investigate the long-term effects of electronic reminders and search for additional features of electronic reminding to improve adherence in the long-term," they write.

Advances in technology, they note, will probably help spur improvements in the way reminders are delivered and in how effective they are. "The increasing opportunities of new technologies make it possible to tailor reminding both in timing (only when needed) and in content (tailored messages)," they write. "In this way, long-term improvements in medication adherence may be achieved."

The authors have disclosed no relevant financial relationships.

J Am Med Inform Assoc. Published online April 25, 2012. Abstract