Research shows that text messages may be ineffective as reminders to refill medications

A study published in JAMA reveals text message reminders for patients who delay refilling their medications did not help them maintain regular medication refills for a year.

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

“There are many studies focusing on the use of technology to improve behavior in healthcare. However, it is unclear and under-researched whether text message reminders are effective over a longer period of time as they have become a common practice in the healthcare,” said first author Michael Ho, MD, adjunct professor in the department of medicine and cardiology at the University of Colorado School of Medicine at the University of Colorado Anschutz Medical Campus.

“That’s one of the reasons we wanted to focus on text message reminders for medication refills in this study, which we hoped would also reduce serious health problems.”

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

“An important factor in our research was including representation from diverse backgrounds, because different cultures and experiences can shape preferences for communication methods and result in varying technology behaviors,” said senior author Sheana Bull, Ph.D., MPH, professor emerita and advisor to the mHealth Impact Laboratory at the Colorado School of Public Health on the CU Anschutz Medical Campus.

The study found that adherence improved by five percentage points during the first three months and the median length of initial breaks was reduced by approximately five days, meaning patients had five more days of medication supply.

However, text message reminders were not effective in improving medication adherence 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 consistent across genders and races, and there was no difference between different texting methods.

“Chronic medical conditions are on the rise and managing these conditions often requires patients to take medications long-term. It is important to identify strategies to help patients take their medications regularly to prevent these medical conditions from worsening,” adds Hi.

“Our research shows that adherence to chronic cardiovascular medications has been low over the past 12 months, and so we need to test new strategies to improve this, especially as more and more people develop chronic medical conditions.”

The researchers will then investigate whether more advanced digital technologies, integrating machine learning and artificial intelligence, can improve longer-term medication refill behavior.

This study was conducted by a team from 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.