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 behavior change. The research is likely to be of interest to health care planners looking for effective, low-cost ways to improve medication adherence on a large scale.
Medication adherence is a significant problem in terms of health and well-being. In common diseases like type 2 diabetes and hypertension, keeping to a prescribed medication regime is an essential part of clinical management.
Yet many patients do not 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 National Institute for Health Research 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’ behavior 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 or type 2 diabetes who had symptoms that were not well controlled.
Patients were recruited from eight primary care practices in the East of England and randomly placed into one of two parallel groups. The intervention group, which totaled 79 patients, received a personalized text message and interactive voice response intervention for 12 weeks. The 56 patients in the control group received usual care.
The intervention was personalized 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 personalized 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 behavior of both patients who decide not to take their medicines and those who forget or do not 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%) and 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 3 months, researchers looked at whether the intervention group had different patterns of medication adherence compared to 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 2 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 2 days more than the control group.
Further analysis found that patients in the intervention group improved their adherence because they had reconciled their thoughts about the necessity to take their medications as prescribed, whereas patients in the control group had 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 3 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
Lucy Lloyd, Communications, Primary Care Unit
Filed Under: Behavioural Science Research Group, Featured, GP News, PCU Updates, Research News Tagged With: digital intervention, Katerina Kassavou, medication adherence, Stephen Sutton
Kassavou A, Mirzaei V, Brimicombe J, Edwards S, Massou E, Prevost AT, Griffin S, Sutton S
A Highly Tailored Text and Voice Messaging Intervention to Improve Medication Adherence in Patients With Either or Both Hypertension and Type 2 Diabetes in a UK Primary Care Setting: Feasibility Randomized Controlled Trial of Clinical Effectiveness. J Med Internet Res 2020;22(5):e16629.