Correction: The original version of this story misstated the study population.

Improving medication adherence is on the wish list of many healthcare stakeholders. Given the multitude of reasons why people don’t stick with their prescriptions, there isn’t just one successful modality to improve their adherence.

But a small study suggests using text messages to engage in two-way communication with patients could be more effective than coming at them with a fully developed tool based on the idea that they are simply forgetting. Moreover, it could lead to a more nuanced understanding of exactly why each individual isn’t taking their medication, thereby informing personalized adherence efforts as well as valuable drug efficacy and safety data.  

Looking at de-identified data from 25 patients across different disease states, researchers at Washington University in St. Louis examined the impact of the fully automated, two-way text-messaging intervention program from adherence-focused digital health company Epharmix. In addition to reminding patients to take their meds, Epharmix (referred to as EpxMedTracking by the researchers) also asks why they missed doses and alerts providers to help address the issue in near real time. Researchers found engagement levels to be high, never dropping below 75 percent over an 11-week period, and found that the technology offered opportunities to intervene.

“A distinct strength of our system seems to be detecting when there is an actionable problem with a patient’s regimen, as 62.4 percent of the missed doses were due to 'out of meds,' 'felt better,' or 'felt sick,'" the researchers wrote. “Importantly, this indicates that the EpxMedTracking system can be used to direct provider attention to where it is both needed and most useful, thus making the system well suited to improve the efficiency of provider time and clinical outcomes in a wide range of disease states where non-adherence may be an issue.”

Researchers interviewed people living with HIV to develop the texting program. These patients were specifically selected because medication adherence is critical for them. For the study, researchers also selected from a group that was all considered to be of low socioeconomic status and could thus have many differing reasons as to why they weren’t staying on track with their medications.

While the researchers concede that the technology and interventions are not novel, they write that the “nature of the invention” was, as the Epharmix tool works both as a functional medication reminder as well as a method of categorically identifying the problems that lead to nonadherence. Additionally, it allows for bidirectional patient-provider interaction, they write.

“In theory this should lead to more targeted and effective provider intervention in the realm of medication adherence and improved patient outcomes in a way that would be impossible with other text message–based medication adherence systems,” they write.

They also believed the high engagement rates of the tool suggest feasibility for long-term use, and patients who reported not taking their medications because they were sick – or the medication itself made them feel sick – offered an opportunity to learn more about adverse side effects from the drugs.

“Our data also raises the possibility that the wording and message algorithms of eHealth interventions might affect patient engagement and behavior, which would have important implications for the design of future eHealth interventions as well as the evaluation of the eHealth literature to date,” they write.