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Review of Trials Finds Text Messages Boost Adherence

Mary Caffrey
Medication adherence among patients with chronic conditions is estimated to cost $100 billion in North America.
Text messaging is a proven winner when it comes to improving medication adherence, according to a pooled analysis of 16 trials involving more than 2700 patients published today in JAMA Internal Medicine.

Use of text messages to provide medication reminders, education or just encouragement has gained popularity in recent years as health plans have searched for simple, scalable, and affordable ways to get patients to take medication. 

Poor adherence is cited as one of the most vexing public health issues in the United States, especially when dealing with patients with chronic conditions like diabetes. The authors write that patients who fail to take medication as directed or at all account for “successive hospitalizations, increased need for medical interventions, morbidity, and mortality.”

The authors cite figures putting the cost of poor adherence at $100 billion in North America, and $2000 per patient per year in “excess physician visits.”

The analysis found that mobile phone text messaging approximately doubles the odds of medication adherence, which leads to improved rates rising from 50% to 67.8%. The authors did caution that the trials were of short duration and the medication adherence results were self-reported; future work should examined whether text messaging works for longer periods and affects clinical outcomes.

Authors led Jay Thakkar, FRACP reviewed 16 randomized clinical trials, including 5 that used personalization in the text messages, 8 that used 2-way communication and 8 that used daily text frequency.  The median duration of the trials was 12 weeks, with the median age of the patients 39 years. Of the 2742 patients in the trials, 50.3% were female.

The authors cautioned that the results showed evidence of publication bias, but that did not mean that the positive results were not significant. “Given the simplicity of the intervention and the potential scalability, this finding suggests the text message-based interventions could have substantial potential to improve medication adherence in patients with chronic disease,” the authors write. “Our findings are consistent with previous observations that text messaging can be a useful tool for behavioral change in disease prevention and monitoring and management.”

Why is text messaging effective? The authors speculate that its nonobstrusive nature, combined with its “boundless reach,” makes it a highly effective tool.

The authors wrote that future work on text messaging should examine which patients benefit the most from the method and why; or whether there is greater benefit from varied message content, 2-way communication, or personalization.


Thakkar J, Kurup R, Laba TL. Mobile telephone text messaging for medication adherence in chronic disease: a meta analysis [published online February 1, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2015.7667.

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