BACKGROUND AND PURPOSE:

• Text message reminders are used to encourage medication adherence, but it’s not clear whether they actually help
• Ho et al. (JAMA, 2024) compared different types of text messaging strategies with usual care to improve medication refill adherence among patients nonadherent to cardiovascular medications

METHODS:

• Patient-level randomized pragmatic trial
  • 3 health care systems in Colorado
• Participants
  • Adults with ≥1 cardiovascular condition and ≥1 prescribed medication to treat the condition who had a 7-day refill gap
• Interventions
  • Generic reminders: generic text message refill reminders
    • e.g. “You are due to refill your [drug name]”
  • Behavioral nudge: text refill reminders incorporating behavioral nudges, with invitation to reply
    • e.g. “Hi [name]. We noticed you haven’t refilled your [drug name]. Reply 1= I’ll get them refilled in the next 2 days. Reply 2=I’m still working on a plan to get this done.”
  • Behavioral nudge + chatbot: text refill reminders plus a fixed-message chatbot
    • As above, chatbot asked about common barriers to adherence
  • Usual care
• Study design
  • Randomization stratified by health care system and number of baseline medications
  • Text messages delivered in either English or Spanish (patient preference)
  • Patients had option to reply with questions | Response by clinical pharmacists
  • If no cell phone (9% of participants): interactive voice response automated telephone calls
• Primary outcome
  • Refill adherence: proportion of days covered at 12 months
• Secondary outcomes
  • Emergency department visits
  • Hospitalization
  • Mortality

RESULTS:

• 9501 patients
  • Mean age: 60 years | Female: 47% | Black: 16% | Hispanic: 49%
• At 12 months, there were no significant difference between text message groups and usual care in mean proportion of days covered (P=0.06)
  • Generic: 62.3%
  • Behavioral nudge: 62.3%
  • Behavioral nudge + chatbot: 63.0%
  • Usual care: 60.6%
• After adjustment, there was still no significant difference (P<0.05/3 after multiple testing corrections) in mean proportion of days covered with intervention vs usual care
  • Generic reminder
    • 2.2 percentage points higher (95% CI, 0.3 to 4.2) | P=0.02
  • Behavioral nudge
    • 2.0 percentage points higher (95% CI, 0.1 to 3.9) | P=0.04
  • Behavioral nudge + chatbot
    • 2.3 percentage points higher (95% CI, 0.4 to 4.2) | P=0.02
• There were no differences in clinical events between study groups

CONCLUSION:

• Text messages reminding nonadherent patients to refill their cardiovascular medications did not increase adherence compared to usual care
• The authors state

Text message reminders were not effective in improving refill adherence at 12 months, regardless of the type of message, generic reminders, behavioral nudges, or behavioral nudges + chatbot

Learn More – Primary Sources:

Personalized Patient Data and Behavioral Nudges to Improve Adherence to Chronic Cardiovascular Medications: A Randomized Pragmatic Trial