Digital interventions are effective in helping patients in primary care take the medicines they have been prescribed, according to the first UK study of whether highly tailored text and voice messages are useful as a tool to improve medication adherence.
The new study, called Medication Adherence for Patient’s Support, or MAPS, proves the importance of highly tailored interventions to support behaviour change. The research is likely to be of interest to healthcare planners looking for effective, low cost ways to improve medication adherence on a big scale.
Medication adherence is a significant problem in terms of health and well-being. In common diseases like type two diabetes and hypertension, keeping to a prescribed medication regime is an essential part of clinical management.
Yet many patients don’t take their medicines as prescribed. This often means they become more unwell as their treatment is less effective than if they were able to adhere to it more closely. They may be more likely to suffer complications, and need additional consultations and admissions to hospital.
The new study, funded by the NIHR and led by Katerina Kassavou and Stephen Sutton at the Primary Care Unit, set out to assess whether a specific highly tailored digital intervention would influence patients’ behaviour to improve medication adherence and whether it would be feasible to introduce in primary care. The study focused on medication adherence in patients with hypertension and/or type 2 diabetes, who had symptoms that were not well controlled.
Patients were recruited from 8 primary care practices in the East of England, and randomly placed into one of two parallell groups. The intervention group, which totalled 79 patients, received a personalised text message and interactive voice response intervention for 12 weeks. The 56 patients in the control group received usual care.
The intervention was personalised in response to the needs of different groups of patients: those who decide not to take their medication as well as those who forget or misunderstand their prescription. Patients could record a personalised plan and receive self-monitoring advice, for example. Patients could also change delivery options – they could decrease or increase the frequency of messages or stop the messages.
We found that this highly tailored digital intervention improved medication adherence for all sorts of patients: it seems to change the behaviour of both patients who decide not to take their medicines and those who forget or don’t understand how to take it.’
– Dr Katerina Kassavou, lead author and researcher in the Behavioural Science Group
Researchers found that 100% of the messages that were scheduled were delivered as intended. The majority of the participants found the intervention easy to use (73%), liked the automated voice delivering the voice messages (62%), the content of the messages (71%), and the availability to call and ask questions when needed (51%). Overall, patients were satisfied with the experience of the intervention (76%) and they would recommend it to other people who take medications for a long-term health condition (65%).
After three months, researchers looked at whether the intervention group had different patterns of medication adherence, compared with the control group. They asked patients to report their adherence patterns over the previous week and over the previous month. Refill prescription claims during the last two months were obtained from practice records.
Patients who used the intervention for 12 weeks improved adherence rates: during the last month they took their medication as prescribed for two days more than the control group.
Further analysis found that patients in the intervention group improved their adherence because they have reconciled their thoughts about the necessity to take their medications as prescribed, whereas patients in the control group have not done so.
Delivering the intervention only costs £0.029 per patient per month, and there were no adverse events or additional consultations recorded during the three months.
This is the first trial of a digital intervention in the UK primary care setting. The results suggest that the intervention can be successfully introduced alongside primary care consultations and that it works to improve medication adherence in the group of patients in our study. The method could be scaled up for use with large numbers of people to help address some of the health risks and the costs associated with low rates of medication adherence. We now need more objective outcome data, like urine analysis for detection of antihypertensive medication, to provide more evidence about how effective – and cost effective – these interventions can be.’
– Professor Stephen Sutton, corresponding author and head of Behavioural Science Group, Primary Care Unit
Read the paper
A Kassavou, V Mirzaei, J Brimicombe, S Edwards, E Massou, A Prevost, S Griffin, S Sutton: ‘A highly tailored text and voice messaging intervention improves medication adherence in patients with hypertension and/or type 2 diabetes in UK primary care setting. A feasibility randomised controlled trial of clinical effectiveness‘ JMIR 19 May 2020
Lucy Lloyd, Communications, Primary Care Unit