Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease

Abstract

Adherence to long-term therapies in chronic disease is poor. Traditional interventions to improve adherence are complex and not widely effective. Mobile telephone text messaging may be a scalable means to support medication adherence. OBJECTIVES To conduct a meta-analysis of randomized clinical trials to assess the effect of mobile telephone text messaging on medication adherence in chronic disease. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL (from database inception to January 15, 2015), as well as reference lists of the articles identified. The data were analyzed in March 2015. STUDY SELECTION Randomized clinical trials evaluating a mobile telephone text message intervention to promote medication adherence in adults with chronic disease. DATA EXTRACTION Two authors independently extracted information on study characteristics, text message characteristics, and outcome measures as per the predefined protocol. MAIN OUTCOMES AND MEASURES Odds ratios and pooled data were calculated using random-effects models. Risk of bias and study quality were assessed as per Cochrane guidelines. Disagreement was resolved by consensus. RESULTS Sixteen randomized clinical trials were included, with 5 of 16 using personalization, 8 of 16 using 2-way communication, and 8 of 16 using a daily text message frequency. The median intervention duration was 12 weeks, and self-report was the most commonly used method to assess medication adherence. In the pooled analysis of 2742 patients (median age, 39 years and 50.3% [1380 of 2742] female), text messaging significantly improved medication adherence (odds ratio, 2.11; 95% CI, 1.52-2.93; P < .001). The effect was not sensitive to study characteristics (intervention duration or type of disease) or text message characteristics (personalization, 2-way communication, or daily text message frequency). In a sensitivity analysis, our findings remained robust to change in inclusion criteria based on study quality (odds ratio, 1.67; 95% CI, 1.21-2.29; P = .002). There was moderate heterogeneity (I 2 = 62%) across clinical trials. After adjustment for publication bias, the point estimate was reduced but remained positive for an intervention effect (odds ratio, 1.68; 95% CI, 1.18-2.39). CONCLUSIONS AND RELEVANCE Mobile phone text messaging approximately doubles the odds of medication adherence. This increase translates into adherence rates improving from 50% (assuming this baseline rate in patients with chronic disease) to 67.8%, or an absolute increase of 17.8%. While promising, these results should be interpreted with caution given the short duration of trials and reliance on self-reported medication adherence measures. Future studies need to determine the features of text message interventions that improve success, as well as appropriate patient populations, sustained effects, and influences on clinical outcomes.

A Novel mHealth Approach for a Patient-Centered Medication and Health Management System in Taiwan: Pilot Study (Preprint)

“…Recently, the popularization of internet technology and mobile health (mHealth) tools for public health or medical care purposes have transformed human life significantly [14,15]. The Short Message Service (SMS) text messaging sent by mobile devices using reminder systems have been proven to produce positive effects on medication adherence in chronic disease and healthcare [16][17][18]. Increasing numbers of studies show that mHealth Applications (Apps) have been widely applied in the medical management of patients with cancer [19], diabetes [20,21], cardiovascular disease [22,23] and other chronic diseases [24].…”

Usability of a Mobile Application for Patients Rehabilitating in their Community

“…14 With respect to mobile phones specifically, one meta-analysis of 16 studies showed that mobile phone text messaging led to a significant increase in medication adherence, 15 and a systematic review of Questions pertaining to two features unique to the military system were excluded. seven interventions for cardiovascular disease management found mobile phone applications effective in increasing medication adherence and physical activity.…”

¿Los ecuatorianos con asma tienen preferencias en el uso de tecnologías de la información y comunicación? Estudio piloto

“…Un metaanálisis concluyó que los mensajes de texto podrían aumentar al doble la adherencia a la medicación. 15 Además, un estudio previo encontró que el correo electrónico y los mensajes de texto son los medios electrónicos más populares a través de los cuales los pacientes con asma desean recibir información y preguntar sobre su enfermedad a los médicos. 11 En nuestro estudio identificamos resultados similares, ya que el mensaje de texto fue el más empleado, seguido del correo electrónico.…”