A new large-scale study shows that interactive, tailored text messages can improve medication adherence by 14 percent.

"The program results far exceed our expectations with 44 percent refill rate in the text message group as compared to 30 percent in the non-text group," Rena Brar Prayaga, the paper’s corresponding author and a behavioral data scientist at mPulse Mobile, said in a statement. "In addition to the difference in refill rates, the 37 percent response rate by this older Medicare population was higher than expected and patient feedback was very positive with 96 percent of the patients indicating that the solution was easy to use.”

The study — conducted at Kaiser Permanente Southern California and using technology from mPulse Mobile — included 88,340 Medicare patients (all over age 65) with multiple chronic conditions. Specifically, patients were taking ora diabetes medications, blood pressure medicines, statins, or some combination of the three. The cohorts were not randomized. All patients were given the option to sign up for text messages, but only 12,272 opted in, leaving 76,068. Both groups received traditional adherence aids like automated and non-automated phone calls reminding them to refill prescriptions.

The mPulse Mobile platform instigated an automated dialogue through which patients could get prescriptions refilled, ask questions, or explain why they had not refilled their prescription. Eighteen percent of text message dialogues resulted in refill requests.

Researchers also used natural language processing to parse the tone of patient responses to the automated message. About half were neutral, 41 percent were positive or very positive, and just 9 percent were negative or very negative. When asked directly whether the service was easy to use, 95 percent of those who responded said yes and 5 percent said no.

“It is worth noting that patients in the texting group engaged at a much higher rate than predicted,” researchers wrote in the study. “We had estimated that the patient response rate would be between 10 percent and 20 percent. … Our target refill request rate was 5 percent to 7 percent since we were messaging an older patient population. At the same time, we hoped that the ease of use of the refill dialogue might draw in more patients and nudge them toward completing their refill requests. The program results far exceeded our expectations. Throughout the three-month program, the response rate was around 37 percent, and the three-month average refill request rate was 18 percent.”

Based on the success of the program, Kaiser Permanente intends to deploy it at additional locations.