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Digital Tools Useful for Medication Adherence in Older Patients

Most patients responded to text messages requesting a medication refill, improving medication adherence in older patients with chronic illness.

digital text message medication adherence

Source: Thinkstock

By Sara Heath

- Text messaging technology can help improve medication adherence rates in older Medicare patients by up to 14 percent, according to a recent study published in the Journal of Medical Internet Research.

This finding comes as many healthcare professionals grapple with conflicting understanding of older patient technology use.

Medication adherence is a pressing issue in the US healthcare market. Between 50 and 60 percent of all chronically ill patients have low medication adherence rates, the researchers reported. This issue causes nearly 125,000 deaths annually and costs the US millions in healthcare spending.

Medication non-adherence is an especially pressing issue for elderly patients, who take an average of seven medications daily and manage a litany of chronic diseases. It is often difficult for these patients to manage their pills, remember refills, or afford so many medications.

Health technologies such as medication reminders have proven beneficial for improving medication adherence rates, previous studies have indicated. But how do these technologies fare with an older crowd that may or may not understand and use technology?

Most older patients (78 percent) own a phone, although fewer own a smartphone, the researchers reported. Additionally, nearly all older patients who self-identify as technology savvy believe they should be able to digitally request pill refills.

The research team, hailing from Kaiser Permanente Southern California, set out to do just that for its Medicare population. The team created automated SMS text message reminders to target patients over age 65 who manage at least one chronic illness.

About 12,000 patients used the text messages, while 76,000 patients received regular care. Over the course of the three-month pilot, 505 patients dropped out of the intervention group.

On the whole, the researchers were pleasantly surprised by the effectiveness of the text message reminders. Medication refill rates – the metric by which Medicare measures medication adherence – went up 14 percent among text message users. This result was higher than the researchers’ predicted results of 5 to 7 percent improvement.

Patients tended to be swift in requesting medication refills following a text message alert, the researchers found. Forty-eight percent of patients requested refills after 24 hours, but many also requested refills within 2 hours of receiving a reminder (37 percent). On average, patients took eight hours to request a refill.

Patients reported moderate satisfaction with the tool. Most patients responded to messages neutrally, the researchers stated, but some expressed enthusiasm for the reminders.

The tool was also reportedly very usable, which potentially explains why the results were better than expected for an older population.

This study helps to disprove the misconception that older patients are not receptive to technology interventions for patient engagement. Many savvy, or at least comfortable, technology users are starting to age into the Medicare age bracket, meaning that providers cannot discount these tools among their older populations.

Going forward, the researchers plan on making some changes to the text messaging system. For example, the current intervention does not make considerations for the social determinants of health, a change the team intends on making soon.

The researchers plan to incorporate interventions that would account for rural dwellers, income and financial issues, or language and cultural barriers. The team likewise plans on altering the text messaging system for non-English-speakers and those with lower levels of health literacy.

These fixes may increase patient access to the tool, which the researchers concluded was an effective strategy for medication adherence.

“Findings suggest that partially adherent or nonadherent Medicare patients who receive interactive text message refill reminders have significantly higher medication refill rates compared to similar patients who do not receive text message refill reminders,” the researchers concluded.

“Results of the program include increased refill rates and high levels of patient engagement. These results should provide insights for developing similar models that represent an elevated standard of care within patient management.”

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