Mobile Phone Text Messaging for Medication Adherence

Study Questions:

Does text messaging improve medication adherence in chronic disease?

Methods:

This meta-analysis included randomized clinical trials (RCTs) that evaluated a mobile phone messaging intervention with the outcome of medication adherence. The trials needed to include adults with chronic conditions. Trials were identified through a search of 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. The primary outcomes of interest were odds ratios (ORs), and pooled data were calculated using random-effects models. Risk of bias and study quality were assessed as per Cochrane guidelines. Chronic conditions included coronary artery disease, dyslipidemia, hypertension, and diabetes.

Results:

Of the 1,987 records identified, removing duplicates and studies ineligible for inclusion, a total 16 RCTs were included. Five of the studies used personalization messaging, eight used two-way communication, and eight used 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, a total of 2,747 patients were included (median age was 39 years and 50.3% were female). Text messaging was significantly associated with improved medication adherence (OR, 2.11; 95% confidence interval [CI], 1.52-2.93; p < 0.001). Study characteristics including intervention duration, chronic disease characteristics of the population, or text message characteristics (personalization, two-way communication, or daily text message frequency) did not appear to significantly influence the effect size. In a sensitivity analysis, findings remained robust to change in inclusion criteria based on study quality (OR, 1.67; 95% CI, 1.21-2.29; p = 0.002). There was moderate heterogeneity (I2 = 62%) across clinical trials. After adjustment for publication bias, the point estimate was reduced, but remained positive for an intervention effect (OR, 1.68; 95% CI, 1.18-2.39). The effect observed 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%.

Conclusions:

The investigators concluded that mobile phone text messaging approximately doubles the odds of medication adherence. While promising, these results should be interpreted with caution given the short duration of trials and reliance on self-reported medication adherence measures.

Perspective:

This meta-analysis highlights the potential for improvement in management of chronic conditions using simple interventions. Leveraging technology highly prevalent in populations across socioeconomic groups can complement current medical management. As the authors point out, further study is warranted including long-term trials and those with diverse populations.

Clinical Topics: Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Prevention, Hypertension

Keywords: Cellular Phone, Chronic Disease, Coronary Artery Disease, Diabetes Mellitus, Dyslipidemias, Hypertension, Medication Adherence, Mobile Applications, Primary Prevention, Risk, Self Report, Text Messaging


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