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Text Messaging: A Cure for Common Nonadherence?

by Craig Klugman, Ph.D.

According to research studies on medication usage, nearly 22% of all e-prescriptions and 28% of new prescriptions are not filled. For heart medications among people who have experienced a heart attach, one-half to two-thirds (depending on the medication) of patients were nonadherent to a prescription regimen. Patient adherence to medication is related to the disease, side effects, how long they are treated (there is a drop off after 6-months of treatment), complexity of the regimen, severity of disease, and cost of the medication.

Nonadherence can increase the cost of treating patients. Estimates on that cost vary but range from $100 to $290 billion each year and $7,800 per patient. Patients with chronic diseases who do not adhere to a prescribed medical regiment have higher death rates, more hospitalizations, more emergency department visits, and more physician visits.

A new study out of the U.K. found that one way to reduce nonadherence is through text messages. In a trial of 303 patients prescribed drugs to lower medication or lipid-levels, half were sent daily text messages either every day (or alternate days) for two weeks following by weekly texts for 22 additional weeks. In a self report, patients were asked about whether they took their medication, whether the text was an important reminder, and if they did not take their medication, whey they did not do so. Patient medication levels were measured after 6 months. In the control group, about 25% of patients were nonadherent (defined as taking less than 80% of medication) compared to 9% in the experimental group.

In the U.S., a consortium of consumer groups, pharmaceutical companies, professional organizations, and pharmacies have created a program called “Script Your Future” which allows patients to sign up for text message reminders. The sign-up asks you to name your reminder, give a phone number, give a start date and time, and how often you wish to receive a reminder. You can cancel at any time.

In public health, it has been known that directly observed therapy and prompts help encourage people to comply with health behaviors. In one sense, these adherence programs aim to do just that—remind people to take care of their health. But in a more insidious sense, these reminders are a way to generate sales. The more medications you take, the more refills you need. What is the intent of such programs? Is it to improve our health or is to improve the health of the bottom line. The outcome may be the same in both cases—improve adherence leading to potentially better health as well as increased profits.

From a double effect perspective, this would be an acceptable program since the good outcome outweighs the bad. But double effect also asks what is the intention for the decision. Thus, the reason for the creation of these programs is important. Such programs are deliberatively coercive, attempting to change decision-making behaviors toward options that other people have decided are the right ones.

These studies and programs look at increasing medication usage. What is missing from these programs and studies is data on whether adhering to a medical regimen does increase health. Until a study shows that these programs increase levels of health, and not just levels of medication in a body, we should approach them with hope and criticism. We know these programs improve profits, now we need proof that they increase longevity and health.

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