Medication nonadherence is a well-recognized challenge associated with poor health
outcomes and increased utilization of health care resources. Although many different
behavioral and educational strategies are available to improve patient medication
adherence, technological advances, including cell phone text messaging, represent
new and innovative modalities to improve adherence and overall health outcomes.
To evaluate medication adherence among patients opting to receive text message medication
reminders and a well-matched control cohort.
This retrospective, observational cohort analysis compared medication adherence of
members who opted-in to the text message medication reminder program and a matched
control cohort using data from a member portal database and electronic pharmacy claims
of a national pharmacy benefit manager with commercial and Medicare membership. Continuously
enrolled members who opted to receive at least 1 medication-specific dosage reminder
for a chronic oral medication of interest and had at least 1 pharmacy claim for the
same chronic oral medication of interest were included. Matching was based on medication
therapeutic class, then on propensity score (including variables of age, sex, health
plan, Chronic Disease Score, distinct medication count, average baseline medication
adherence, and duration of therapy). The primary outcome was chronic oral medication
adherence, measured as the proportion of days covered (PDC), between January 1, 2011,
and August 31, 2011. Analyses comparing cohorts were conducted using paired t tests and the McNemar test.
After implementation of the text messaging program, the mean (SD) PDC was significantly
higher for the text message cohort (n = 290) than for the control cohort (n = 290)
(0.85 [0.20] vs 0.77 [0.28], respectively; P < 0.001). Of those members identified with a chronic oral antidiabetes medication,
the mean PDC was significantly higher in the text message cohort than in the control
cohort (0.91 [0.14] vs 0.82 [0.21]; P = 0.029). Significant differences in mean PDC were also seen in members who opted
to receive text message reminders for β-blocker therapy over members in the control
cohort (0.88 [0.18] vs 0.71 [0.29]; P = 0.006).
Findings suggest that members opting into a text message reminder program have significantly
higher chronic oral medication adherence compared with members not opting to receive
medication-specific text message reminders, and that the use of a text message reminder
program assists in preserving higher rates of adherence over time.