Text messages can be ineffective as medication refill reminders

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A study published in the Journal of the American Medical Association (JAMA) on December 2, 2024, revealed that text message reminders for patients who delay refilling their medications did not improve medication adherence over the course of a year. The study specifically analyzed patients that were non-adherent to their cardiovascular medications.

Researchers conducted a pragmatic randomized trial of 9,501 patients across three U.S. health care systems, testing three text messaging medication refill reminder strategies: (1) generic reminders, (2) behavioral nudge reminders (messages employing persuasive communication strategies) and (3) behavior nudge reminders combined with a fixed message chatbot. None of the tested strategies increased refill adherence at 12 months.

“There are a lot of studies that focus on using technology to improve health care behaviors. However, it’s unclear and under-studied whether text message reminders are effective for a sustained period, given they have become a commonly used practice in health care settings,” said Michael Ho, MD, first author of the study and professor adjoint in the department of medicine and cardiology at the University of Colorado School of Medicine. “That’s one of the reasons why we wanted to focus on text message reminders for refilling medication in this study, which we were hoping would also decrease serious health issues.”

Notably, researchers found that refill adherence over the first three months of the study improved by 5% and the median length of initial gaps decreased by approximately five days, which meant patients had five more days of their medication supply. However, text message reminders were not effective in improving refill adherence at 12 months, which remained true regardless of the type of text message and was consistent for all genders and races included in the study.

“Chronic medical conditions are increasing and controlling these conditions often requires patients to take medications long term,” Ho explained. “It’s important to identify strategies to help patients take their medications regularly to prevent these medical conditions from worsening. Our study shows adherence to chronic cardiovascular medications was low over 12 months, and therefore, we need to test new strategies to improve this, especially as more people are developing chronic medical conditions.”

The study included representation from a diverse population across subgroups, which included females, Hispanic patients and Spanish-speaking patients, all of which are groups that can be traditionally underrepresented in clinical trials. Text messages were sent to patients when they had a refill gap that was greater than one week, and messages were sent in either English or Spanish, based on patients’ language preferences.

“An important factor of our research was to include representation from a wide range of backgrounds since different cultures and experiences can shape preferences for communication methods and result in varying technology behaviors,” Sheana Bull, PhD, MPH, senior author of the study, professor emerita and advisor to the mHealth Impact Laboratory at the Colorado School of Public Health, said in a university release.

The researchers expressed interest in continuing research in this area. Next, they plan to conduct studies to determine the impact that machine learning and artificial intelligence (AI) can have on patients’ long-term behaviors related to medication refills.