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Can Cell Phone Patient Engagement Reduce Medication Non-Adherence?

mHealth and cell phone interventions may be effective in reducing medication non-adherence, but research shows there are gaps in its effectiveness in different patient populations.

- Older, non-white patients of lower socioeconomic status may be harder to engage with in order to reduce medication non-adherence, according to a recent study in the Journal of the American Medical Informatics Association (JAMIA).

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Researchers sought to determine how mHealth tools – specifically cell phone and smart phone patient engagement tools – can improve medication non-adherence in minority patient populations.

A total of 80 diabetic patients were enrolled in an experimental program, MEssaging for Diabetes (MED), which utilized three cell and smart phone functions to remind patients of and engage them in their medication plans.

First, the program sent a daily text message addressing user-specific barriers to medication adherence. Later in that same day it sent a two-way message asking whether the patient had taken their medication. This message required a yes/no response. Last, the system sent a weekly automated phone call providing the user with medication adherence feedback, and a two-way question and answer session asking about patient barriers to medication adherence.

On the whole, the research team found that this kind of mHealth intervention was reasonably effective. Nearly 80 percent of patients responded to text message inquiries, while just over half responded to the phone call inquiries.

However, when examining the research participants based on different population characteristics, the researchers saw significant differences.

The most responsive patients tended to be between the ages of 25 and 50, with those older than 50 responding to fewer texts that those middle-aged.

Although the researchers did not pose a potential reason as to why this difference occurred, they did state that these findings were consistent with other research, which shows that individuals ages 30-49 years are more likely to engage in more cell phone usage.

Ethnicity also played a role in the likelihood of cell phone engagement. Non-white participants were less likely to respond to phone calls, a result which may be explained by cultural nuances.

“Different factors impact the engagement of minorities with T2DM in diabetes interventions, including culturally competent approaches,” the research team explained. “Although the MED intervention included tailored content addressing patient-specific barriers to adherence, it did not address population-specific barriers to adherence that may include cultural nuances. Not accounting for such nuances might have diminished the engagement of minorities.”

Low patient engagement was also due to low health literacy. According to the research team, those who have lower engagement levels with internet and mHealth interventions tend to have lower levels of health literacy.

Although the research team did not specifically investigate potential methods to overcome barriers of health literacy, they did hypothesize that better engagement of patients’ families and other members of the support team may be effective.

The research team also identified a low patient engagement pattern with those displaying symptoms of depression. On the whole, these patients were less likely to respond to text message interventions. These patients were also less likely to remain adherent to their treatment plans.

“The sense of hopelessness associated with depressive symptoms may contribute to suboptimal engagement with a variety of health-related behaviors,” the researchers noted.

While the researchers were successful in identifying various characteristics that are barriers to mHealth patient engagement strategies, they said more research was necessary to understand how to overcome those barriers.

“After identifying the reasons for less engagement, mHealth interventions can be customized to different user groups,” the research team stated. By customizing mHealth interventions directly to various patient sub-populations, the researchers could implement more ubiquitous patient engagement strategies to more fully reduce medication non-adherence.

Reducing medication non-adherence is an important goal for the healthcare industry, especially considering its high costs. As of early 2015, medication-nonadherence was costing the healthcare industry millions of dollars in avoidable expenditures.

As the industry continues to shift to patient-centered care that values overall patient wellness rather than the volume of services administered, providers will need to find better patient engagement strategies to ensure that chronically ill patients are maintaining their treatment plans, reducing the risk for adverse health outcomes and avoidable costs.