Text message reminders fail to boost long-term medication adherence

A new study published today in JAMA reveals text message reminders for patients who delay refilling their medications didn’t help improve how regularly they refilled medications over a year.

The study enrolled over 9,000 patients in a randomized pragmatic clinical trial and included representation from a diverse population across subgroups, including females, Hispanic ethnicity and Spanish-speaking patients, all groups who can be traditionally underrepresented in clinical trials.

There are a lot of studies that focus on using technology to improve healthcare behaviors. However, it’s unclear and under-studied 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 why we wanted to focus on text message reminders for refilling medication in this study, which we were hoping would also decrease serious health issues.”

Michael Ho, MD, first author, professor adjoint in the department of medicine and cardiology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus

The researchers compared different types of text messaging strategies to usual care to improve medication refill adherence for chronic cardiovascular medications. Messages were delivered when patients had a refill gap of more than seven days and sent in either English or Spanish based on patients’ language preference.

“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,” said 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. The mHealth Impact Laboratory is an incubator for innovative health technology and disease management initiatives.

The research found refill adherence over the first three months improved by five percentage points and the median length of initial gaps was reduced by approximately five days, meaning patients had five more days of their medication supply. However, text message reminders were not effective in improving refill adherence at 12 months, regardless of the type of message: generic text messages, messages using persuasive communication strategies called behavioral nudges or behavioral nudges plus a chatbot. This was consistent for all genders and races, and there was no difference between the different text message methods.

“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 are developing chronic medical conditions,” adds Ho.

The researchers will next study if more advanced digital technologies incorporating machine learning and artificial intelligence can improve longer term behaviors related to medication refills.

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