Mobile text messaging may improve medication adherence

1. Based on meta-analysis data, mobile phone text messaging doubled the odds of medication adherence amongst middle-aged adults with chronic diseases.

2. Given the ubiquity of cellphones amongst the middle-aged and younger generations, mobile phone medication reminders could have a significant impact on public health. However, this may not be translatable to the elderly at this point in time.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Medication adherence is often an issue in management of chronic illnesses. However, tools such as mobile device texting or other mobile applications may be a currently underutilized strategy that can improve adherence, and thus public health. This meta-analysis reviewed randomized clinical trials (RCT) to assess the effect of mobile telephone text messaging on medication adherence for chronic diseases.

Mobile phone text messaging doubled the odds of medication adherence amongst middle-aged adults with chronic diseases. Strengths of this meta-analysis included analysis of important chronic diseases where medication adherence is important. Limitations included use of self-report for medication adherence, small sample size of the eligible RCTs, and publication.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Interventions for enhancing medication adherence

In-Depth [systematic review and meta-analysis]: A computerized literature search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO and CINAHL databases was conducted from inception to January 15, 2015. Randomized controlled trials that evaluated mobile telephone text message interventions to promote medication adherence in adult chronic disease were deemed eligible for inclusion, and two authors independently reviewed and extracted information on study characteristics, text message characteristics, and outcomes. Methodological risk of bias was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Statistical analysis included assessment of effect size to pool estimates, I² statistic for heterogeneity, and publication bias funnel plot assessment.

Of the 44 full-text reviews, 16 RCTs met inclusion criteria for the final meta-analysis, which represented over 2,700 patients. The median sample size was 97 and studies evaluated various chronic diseases, including HIV infection, cardiovascular disease, asthma, allergic rhinitis, diabetes, and epilepsy. Self-report was the most common method used to assess medication adherence. Text message intervention characteristics included personalized texts, 2-way communication, or daily text messaging. In the pooled analysis, text message interventions significantly improved medication adherence (OR 2.11, 95% CI 1.52-2.93; P<0.001). These results remained robust through subgroup analyses. There was moderate heterogeneity (I²= 62%). After adjustment for publication bias the intervention effect still remained (OR 1.68, 95% CI 1.18-2.39).

Image: PD

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