Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 15;6(5):e87.
doi: 10.2196/resprot.7223.

EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence Tracking System in Community Practice

Christopher Tricarico  1 , Robert Peters  1 , Avik Som  1   2 , Kavon Javaherian  1 , Will Ross  1
Affiliations

EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence Tracking System in Community Practice

Christopher Tricarico et al. JMIR Res Protoc. .

Abstract

Background: Medication adherence remains a difficult problem to both assess and improve in patients. It is a multifactorial problem that goes beyond the commonly cited reason of forgetfulness. To date, eHealth (also known as mHealth and telehealth) interventions to improve medication adherence have largely been successful in improving adherence. However, interventions to date have used time- and cost-intensive strategies or focused solely on medication reminding, leaving much room for improvement in using a modality as flexible as eHealth.

Objective: Our objective was to develop and implement a fully automated short message service (SMS)-based medication adherence system, EpxMedTracking, that reminds patients to take their medications, explores reasons for missed doses, and alerts providers to help address problems of medication adherence in real time.

Methods: EpxMedTracking is a fully automated bidirectional SMS-based messaging system with provider involvement that was developed and implemented through Epharmix, Inc. Researchers analyzed 11 weeks of de-identified data from patients cared for by multiple provider groups in routine community practice for feasibility and functionality. Patients included were those in the care of a provider purchasing the EpxMedTracking tool from Epharmix and were enrolled from a clinic by their providers. The primary outcomes assessed were the rate of engagement with the system, reasons for missing doses, and self-reported medication adherence.

Results: Of the 25 patients studied over the 11 weeks, 3 never responded and subsequently opted out or were deleted by their provider. No other patients opted out or were deleted during the study period. Across the 11 weeks of the study period, the overall weekly engagement rate was 85.9%. There were 109 total reported missed doses including "I forgot" at 33 events (30.3%), "I felt better" at 29 events (26.6%), "out of meds" at 20 events (18.4%), "I felt sick" at 19 events (17.4%), and "other" at 3 events (2.8%). We also noted an increase in self-reported medication adherence in patients using the EpxMedTracking system.

Conclusions: EpxMedTracking is an effective tool for tracking self-reported medication adherence over time. It uniquely identifies actionable reasons for missing doses for subsequent provider intervention in real time based on patient feedback. Patients enrolled on EpxMedTracking also self-report higher rates of medication adherence over time while on the system.

Keywords: eHealth; medication adherence; text messaging.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: AS has a financial conflict of interest as a founder of Epharmix. All other authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Web portal.
Figure 2
Figure 2
The workflow of messages and care managers used in EpxMedTracking. (A) Patients are initiated on EpxMedTracking with verbal consent to use. (B) EpxMedTracking assesses medication adherence and common issues. (C) A triage engine determines which patients can be aided in medication adherence (eg, running out of medication, a medication side effect) and care managers reach out to close the loop. Figure courtesy of Epharmix.
Figure 3
Figure 3
Text message workflow of the EpxMedTracking system.
Figure 4
Figure 4
Patient engagement rates to EpxMedTracking normalized by week during the study period.
Figure 5
Figure 5
Patient engagement rate over time normalized by day.
Figure 6
Figure 6
Reasons reported for missing medication doses in both the pilot and study period of EpxMedTracking.
Figure 7
Figure 7
Self-reported medication adherence of patients who responded to the EpxMedTracking system.
See this image and copyright information in PMC

References

    1. Brown MT, Bussell J, Dutta S, Davis K, Strong S, Mathew S. Medication adherence: truth and consequences. Am J Med Sci. 2016 Apr;351(4):387–399. doi: 10.1016/j.amjms.2016.01.010. - DOI - PubMed
    1. van Dulmen S, Sluijs E, van Dijk L, de Ridder D, Heerdink R, Bensing J. Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res. 2007 Apr 17;7:55. doi: 10.1186/1472-6963-7-55. https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-7-55 - DOI - DOI - PMC - PubMed
    1. Viswanathan M, Golin CE, Jones CD, Ashok M, Blalock SJ, Wines RC, Coker-Schwimmer EJ, Rosen DL, Sista P, Lohr KN. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012 Dec 4;157(11):785–795. doi: 10.7326/0003-4819-157-11-201212040-00538. - DOI - PubMed
    1. Miller EA. Solving the disjuncture between research and practice: telehealth trends in the 21st century. Health Policy. 2007 Jul;82(2):133–141. doi: 10.1016/j.healthpol.2006.09.011. - DOI - PubMed
    1. Head KJ, Noar SM, Iannarino NT, Grant HN. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Soc Sci Med. 2013 Nov;97:41–48. doi: 10.1016/j.socscimed.2013.08.003. - DOI - PubMed