If you are diagnosed with a chronic disease, chances are you’ll have to manage it for the rest of your life. This means changing your lifestyle and taking medications as directed.
Many find this challenging. In fact, within a year of being diagnosed with a chronic condition, only 50% of patients still take their medications correctly.
Some have stopped altogether. These patients can unwittingly put themselves at greater risk of heart attack, stroke or premature death. So how can we ensure this doesn’t happen?
Why you should take your medication
Chronic conditions such as cardiovascular disease, diabetes, cancers, arthritis and high blood pressure are on the rise all over the world.
As a cardiovascular specialist, I see patients living with heart disease every day. They may have survived their first heart attack but are now at greater risk of having a second.
We do everything we can to prevent that second, often fatal, attack by encouraging people to change their lifestyle and, just as importantly, to take their medications as directed.
This is because poor adherence to a medication routine – when patients don’t take their medications consistently or just stop taking them altogether – is naturally associated with worse health outcomes.
One study showed survivors of a heart attack who adhered poorly to cholesterol-lowering drugs (statins) had a 25% higher risk of a fatal heart attack one year on.
Why don’t people take their medication?
Many people with a chronic illnesses don’t always feel sick. Medications are intended to prevent their condition from worsening rather than to make them feel better in the short run. Because they don’t feel immediate benefits, it’s easy to think the medications are not working, which can lead to patients stopping them altogether.
For some, it’s the cost factor. Studies looking at cholesterol-lowering statins have shown higher prices are associated with lower adherence.
Those with chronic diseases are often on multiple medications. Some of these they have to take once a day, some twice a day, others with meals, some before meals – all of this makes for a complex routine that can be confusing to follow.
Not having convenient access to a pharmacy can also be a barrier to medication adherence. This is usually a problem for the more vulnerable, such as those on a pension, those from a lower socioeconomic background, shift workers, those dependent on others for transport and those who have mobility problems.
And finally, there are people who are wary of drugs and perceived side effects.
A 2010 study in [adults with high blood pressure](http://www.internationaljournalofcardiology.com/article/S0167-5273(16)30032-8/abstract) in Spain found reasons for patients not adhering to their medication regime included having to take several medications at once, having a mental illness, living in a rural area and being younger.
How we can improve medication adherence
Patients need support and encouragement to take their medications and SMS messaging is a simple, cheap and seemingly effective way to keep them on track.
A 2015 study in the United Kingdom showed a 20% increase in women attending breast cancer appointments after receiving text reminders.
Asthma patients in a Danish trial are keeping SMS diaries to help them monitor and manage their condition.
And another study last September found patients with chronic pain had a significant reduction in pain when they received supportive daily text messages.
We reviewed 16 randomised clinical trials around the world evaluating mobile text messaging to promote medication adherence in adults with chronic disease.
The way the text message alerts worked in the studies were varied. In one, patients were sent a text when they failed to open a medication dispenser; others were sent personalised texts at predetermined times about specific medications and dosages. Some were sent daily, others weekly.
Regardless of the method, we found text messaging doubled the odds of patients with chronic diseases sticking to their medication program.
But the studies we surveyed were held over an average of twelve weeks. We’re currently running a text messaging trial to be sure it works over longer periods.
Our TEXTMEDS study is taking place at twenty urban and rural hospitals across Australia, involving 1,400 patients with cardiovascular disease. We hope to show these innovative and cost-effective strategies can help large numbers of people over the long term.
Global governments and policymakers should look closely at the research for an effective and inexpensive method of text message reminders that can help get patients with chronic diseases to take life saving medications.