Health Information Technology: Text Messaging Interventions for Medication Adherence Among Patients with Chronic Diseases

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to chronic disease prevention.

Thakkar J, Kurup R, Laba TL, Santo K, Thiagalingam A, et al. Mobile telephone text messaging for medication adherence in chronic disease. JAMA Internal Medicine 2016;176(3):340-9.

The review included 16 randomized controlled trials (search period through January 2015). The team examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.

There is no information for this section.

More details about study results are available in the CPSTF Finding and Rationale Statement.

The systematic review included 16 studies.

• Medication adherence improved significantly (16 studies).

Evidence from a subset of seven studies conducted in high-income countries was used as the basis for the CPSTF recommendation.

• Medication adherence, measured either by patient or dose, increased by a median of 13.8 percentage points (7 studies).

An economic review of this intervention was not conducted.

• The CPSTF finding should be applicable to U.S. adults who are taking medications for a chronic condition.
• The CPSTF assessment on applicability focused on the subset of seven studies from high-income countries.
  
  • The subset of studies were conducted in the United States (2 studies), Denmark, England, France, The Netherlands, and Spain (1 study each).
  • Patients were recruited from hospitals or clinics (5 studies), pharmacies (1 study), and communities (1 study).
  • Studies evaluated interventions with patients who were taking medications for hypertension (1 study), heart disease (3 studies), diabetes (1 study), HIV (1 study), and asthma (1 study).
• Although evidence for specific settings and patient characteristics is limited or absent, the intervention is simple and focused on improving a basic patient self-management behavior.

The systematic review by Thakkar et al. identified the following areas for future research.

• Longer duration evaluations based on objective measures of medication adherence and inclusion of clinical outcomes
• Benefits of different features of text message interventions

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base. (What are evidence gaps?)

• Are text messaging interventions effective when implemented and evaluated over longer periods of time (1-2 years)?
• Are these interventions also effective in improving clinical outcomes and health care use, and in reducing morbidity and mortality?
• How does intervention effectiveness vary when
  • Recruitment of clients occurs in workplaces or community settings?
  • Implemented for patients who vary by race, ethnicity, or socioeconomic status?
  • Implemented for patients at the initiation of medical management?
  • Implemented for patients with previously low adherence?
  • Based on new or existing mobile-phone applications?
  • Combined with additional interventions to improve patient self-management and clinical care?
• Are text messaging interventions effective when implemented and evaluated with larger samples of U.S. patients living with HIV?

• All of the included studies were randomized controlled trials.
• Studies examined the effectiveness of text messaging interventions in improving patients’ medication adherence.
• In all of the studies, text messaging interventions were implemented alone, without additional patient or clinical system interventions.
• Study participants had a variety of chronic medical conditions and lived in either developed or developing countries.
• Evaluated interventions sent text messages daily (8 studies), weekly (3 studies), or on a dose-timed frequency (4 studies).
• Interventions were of short duration (median 14 weeks).
• Studies sent automated text messages (10 studies), employed two-way communication with healthcare providers (8 studies), and sent patients personalized messages (5 studies).