Free Personalized Text Messages Remind Patients To Take Medications Interview with:
Avinash Pandey,
the study author, is a high school student who conducted this study under the guidance of his mentor, Niteesh K. Choudhry., M.D., Ph.D., executive director of the Center for Healthcare Delivery Sciences, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Medical Research: What is the background for this study? What are the main findings?

Response: Numerous studies have demonstrated that there is poor adherence to medications in cardiac patients (coronary artery disease patients, CAD). Despite the fact that non-adherence to these medications can have serious consequences on long-term health like disease progression, increased risk of cardiac events and premature mortality, many patients consistently miss their medications and many stop their medications only months after they are prescribed. This non-compliance leads to high costs for the health care system and more potentially preventable cardiac events. Studies suggest, that for the vast majority of patients, non-adherence to medications is not intentional. A significant portion simply forget to take their medications. Although many systems are available today to reduce medication non-adherence, like pill boxes and blisterpacks, these have demonstrated limited effect on medication adherence. Other systems may be expensive to purchase and cumbersome to use or of limited availability. With the proliferation of cellphones, text message reminders could represent a simple, cost-effective method to improve adherence to medications.

This research began as a high school science fair project 4 years ago and has evolved into a large ongoing assessment of the impact of mobile technologies on adherence to evidence based therapies and lifestyle interventions in a broad cross-section of cardiovascular patients and those at risk for cardiovascular disease. The current report examines the impact of an automated computer program which sends free, personalized text messages to remind patients to adhere to their medications. 30 CAD patients were recruited from a single centre cardiac practice, in this 2 month cross-over study. Patients were randomized to either receive text message reminders in the first month or the second month. Adherence of each patient was compared between months. Text message reminders were shown to significantly impact medication adherence. Patients missed on average 60% less doses when receiving text message reminders. These numbers were even greater when looking at pre-specified groups identified in previous studies to be at high risk of medication non-adherence, including depression patients, dementia patients, elderly patients, and patients with less than 12 years of education. All patients improved with text message reminders but those with the lowest adherence improved the most. Although this study did not examine clinical outcomes, the text message reminder system appears to be a simple and widely applicable method to improve adherence to medications. The system is free to operate and represents no cost for patients receiving messages. Thus it could be implemented at an individual level or by physicians and clinics to improve patient adherence to medications.

Medical Research: What should clinicians and patients take away from your report?

Response: This study illustrates the important benefit of mobile technology in modern health practices. As more and more patients continue to use cellphones, simple solutions like text messages can be used to help a growing section of the population. It was found in this study that simple steps like repeated reminders can help to improve adherence to medications. One major advantage of the intervention developed for this study was that it was a computer program designed to send reminders to any type of cell phone, rather than an app, which is restricted to specific brands or types of smartphones. In essence, mobile technology represents an opportunity to develop interventions which are applicable to a wide range of populations while simultaneously having a significant impact on heart health promotion.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Following this study, I have also examined the impacts of this text message reminder system in a number of other populations. This system demonstrated significant improvement in adherence to anti-platelets, b-blockers, ACE-inhibitors and ARBs, and statins in a population of heart attack patients. Additionally, this system has shown important improvements in exercise frequency, exercise duration and aerobic fitness in heart attack patients taking part in cardiac rehabilitation programs. Impacts of this system are also being assessed in diabetes patients in a comparative analysis of burst vs sustained exercise. I am conducting ongoing studies with this system looking at heart failure patients and AFIB patients to potentially improve adherence to both medications and lifestyle interventions. A trial is also ongoing to assess the impact of this text message system in assisting smokers to quit. A comprehensive study examining multi-modality interventions simultaneously for adherence assistance is being developed.

This was a short-term study in a small sample size of individuals. Further studies should assess the effectiveness of similar interventions and over longer timespans and larger, more diverse patient populations. Additionally, text message interventions have the potential to impact other important aspects of cardiovascular health, including diet, and blood pressure optimization. Further research is necessary to determine the potential clinical impacts of such systems.


Automated text messaging may improve heart patients’ adherence to medications

Research presented at the American Heart Association EPI/Lifestyle 2015 meeting. Interview with: Avinash Pandey (2015). Free Personalized Text Messages Remind Patients To Take Medications