Improving Medication Adherence with Two-way Short Message Service Reminders in Sickle Cell Disease and Asthma. A feasibility randomized controlled trial

Abstract

Introduction: Sickle cell disease (SCD) is a childhood and adult disease that primarily affects African Americans, characterized by life threatening sequelae mitigated by medications. One-way and two-way short message service (SMS) medication reminders have differing efficacy in chronic diseases. There is limited literature about SMS medication reminders in SCD.

Objective: The goal of this study was to test the feasibility, defined by recruitment/acceptance, retention/attrition, and technology utilization, of two-way SMS medication reminders in individuals with SCD with and without asthma.

Materials and methods: Participants were randomly allocated to standard care or reminders. Two-way SMS reminders were automated using Research Electronic Data Capture (REDCap) for hydroxyurea, fluticasone, budesonide and montelukast. Adherence was measured using the Morisky Medication Adherence Scale-8 (MMAS-8). Asthma control was assessed using the Childhood and Adult-Asthma Control Tests (ACT). Participants were enrolled 28 to 60 days with a common termination date.

Results: The recruitment rate was 95% (47/49) and 82.9% completed the study. Among the 47 study participants enrolled, 51.1% were male, 61.7% were adults, median age was 20 (range: 3 to 59), and 98% were African Americans. Of the 26 participants receiving messages, 20% responded on over 95% of the days and usage varied with an average response rate of 33%, ranging from 21% to 46%. Medication adherence scores improved significantly in the intervention group (3.42 before, 5.46 after; p=0.002), but not in the control group (3.90 before, 4.75 after; p=0.080). Childhood-ACT scores improved in the intervention group (19.20 before, 24.25 after). Adult-ACT scores within the intervention arm were unchanged (21.0 before, 22.0 after. ACT scores did not improve significantly.

Conclusion: This study demonstrated the feasibility for two-way SMS medication reminders to improve medication adherence in a high-risk population where daily medication adherence is critical to health outcomes and quality of life.

Keywords: Sickle cell anemia; asthma; medication adherence; short message service; text.

Fig. 1

Screenshot of an example of a Research Electronic Capture Database (REDCap) automated survey invitation.

Fig. 2

Morisky Medication Adherence Scale. Self-report tool designed to capture medication adherence behaviors. Each ‘no’ = 1, with the exception of number 5, where ‘yes’ = 1. Item 8 is scored as follows: Never/Rarely = 1, everything else = 0. A score of ≥8 = high adherence; 6 to <8 = moderate adherence; <6 = low adherence.

Fig. 3

Percent of Participants Responding to Text Messages. Childhood Asthma Control Test. Patient and caregiver self-report tool of asthma symptoms in children 4–11 years of age. A score ≤19 indicates uncontrolled asthma.

Fig. 4

Adult Asthma Control Test. Patient self-report tool of asthma symptoms for individuals ≥ 12 years of age. A score ≤19 indicates uncontrolled asthma.

Fig. 5

Test for Respiratory and Asthma Control in Kids. Caregiver self-report tool of asthma symptoms in children under 5 years of age. A score <80 indicates uncontrolled asthma.

Fig. 6

Percent of Participants Responding to Text Messages. Percent of participants in intervention group that responded to text messages. The percent of respondents are on the left y-axis and the total number of participants responding is shown on the right y-axis for each day of the intervention.

Fig. 7

Percent of Partial Responders Responding to Text Messages. Percent of partial responders (responded at least once, but less than 95% of the time) that responded to text messages. The percent of respondents are on the left y-axis and the total number of participants responding is shown on the right y-axis for each day of the intervention.