Texting could promote medication adherence among chronically ill patients

New study in JAMA Internal Medicine demonstrates that text messages are a simple, affordable and effective mobile health strategy

Text messages can double the odds of medication adherence in patients with chronic disease. That is the central finding of a new study published today in JAMA Internal Medicine.

Researchers at The George Institute for Global Health in Sydney, Australia, including Jay Thakkar, a PhD student at The University of Sydney, and Associate Professor Clara Chow, Director of the Cardiovascular Division at the Institute and cardiologist at Westmead Hospital, conducted a systematic review of 16 randomized clinical trials evaluating a mobile telephone text message intervention to promote medication adherence in adults with chronic disease.

“This study furthers my belief that m-Health strategies are one of the simplest, most affordable ways to save lives,” said Associate Professor Clara Chow, Director of the Cardiovascular Division at the Institute and cardiologist at Westmead Hospital. “Global governments and policymakers should look closely at these compelling findings for a scalable, effective and inexpensive method of getting patients with chronic diseases to take their life-saving medicine.”

This study builds on a previous JAMA report, the TEXT ME (Tobacco, Exercise and Diet Messages) study, led by Professor Chow last year, which showed that a simple text message system can improve the health of heart attack survivors by helping to reduce cholesterol, blood pressure and weight.

“Like the TEXT ME study, the results of this are really a no-brainer,” said Professor Chow. “Text messages can save money and save lives, and should be considered as an essential tool in disease prevention, and monitoring and management.”

Improving medication adherence is a global health challenge. Developed countries boast 50% adherence one year after initiation of therapy, with even lower rates in developing countries. Medical experts have employed various interventions to address this challenge, ranging from education to packaged medications to smartphone app reminders.

This study finds text message systems are a practical, inexpensive tool for reaching patients and sharing potentially lifesaving reminders and information. Global adoption of mobile devices is widespread across geographies and economies, with an estimated seven billion mobile subscribers at the end of 2014, making this intervention an accessible and realistic health policy tool for countries around the globe.

In the studies examined, the methods for employing the texts were wide ranging. In one study, patients were sent a text when they failed to open a medication dispenser. In another, personalized text messages were sent at predetermined frequencies with information about specific medicines and dosages. Others included medical education or general, nonmedical information such as humor.

Researchers caution that more research that comprehensively studies what features of programs make them more effective is necessary. In addition, future research with longer trials is necessary to determine the duration of the effect, the time-effect relationship and the continuation or decay of the effect after the intervention is withdrawn.