UCSF

Background: Adherence to medications is critical to prevent morbidity and mortality in patients with coronary heart disease (CHD). Mobile technology may provide an innovative, practical, and inexpensive means to promote medication adherence.

Objectives: The primary aim of this randomized controlled trial was to compare adherence to antiplatelet and statin medications among patients after myocardial infarction and/or coronary stent procedure who: 1) received text messages (TM) for medication reminders and health education (TM Reminders + TM Education), 2) received TM for health education (TM Education Alone), and 3) did not receive TM (No TM). Secondary aims were to: 1) explore feasibility and patient satisfaction, 2) compare self-efficacy, and 3) identify predictors of medication adherence.

Methods: Customized TM were delivered over 30 days. Adherence was assessed with electronic devices [Medication Event Monitoring System (MEMS)], two-way TM response rates, and the Morisky Medication Adherence Scale. Questionnaires on patient satisfaction with TM and self-efficacy were administered.

Results: Among 90 patients (76% male, mean age 59.2 years), MEMS revealed a significant difference in adherence among groups for antiplatelets only (p<.05). The TM Reminders + TM Education group had a higher percentage of correct doses taken (88.0 ± 14.0 vs. 72.4 ± 27.6; p=.016) and a higher percentage of prescribed doses taken on schedule compared to the No TM group (86.2 ± 15.4 vs. 69.0 ± 29.2; p=.01). The TM Education Alone group had a higher percentage number of doses taken compared to the No TM group (95.8 ± 9.5 vs. 79.1 ± 27.7; p=.01). Two-way TM response rates were higher for antiplatelets than statins (90.2 ± 9 vs. 83.4 ±15.8; p=.01). Self-reported adherence improved for all groups over time, but did not differ among groups, similar to findings with self-efficacy. Feasibility was established and high patient satisfaction reported. Less depression and higher social support predicted higher medication adherence at 30 days.

Conclusions: TM increased adherence to antiplatelet therapy demonstrated by MEMS and TM responses. Addressing depression and social support in clinical practice should be a priority to improve medication adherence. Further research is needed to explore the full potential of mobile health.