Nudge Trial: Text Message Reminders Fail to Improve Cardiovascular Medication Adherence
Key Insights
A pragmatic clinical trial, Nudge, found that text message reminders did not significantly improve cardiovascular medication adherence compared to usual care.
The study involved 9501 patients who had delayed refilling their cardiovascular medications and tested various text messaging strategies.
No statistically significant differences were observed in the proportion of days covered with medication or in emergency department visits, hospitalizations, and mortality.
A recent NIH Collaboratory trial, Nudge, revealed that text message-based reminders for patients who delayed refilling their cardiovascular medications did not significantly improve medication adherence compared to usual care. The pragmatic clinical trial, embedded in three healthcare systems, tested various text messaging strategies on 9501 patients.
The study, published in JAMA, aimed to address the common issue of poor medication adherence among patients with chronic conditions, which is associated with higher rates of adverse health outcomes, including hospitalization and mortality. Patients were randomized to receive either usual care or one of three text message interventions: a generic reminder, a reminder incorporating behavioral nudges, or a behavioral nudge reminder plus a chatbot to address barriers to adherence.
The primary outcome measured was the proportion of days covered in the 365 days after randomization for all cardiovascular medication classes with a refill gap at baseline. The results indicated no statistically significant differences in medication adherence between the study groups. Furthermore, no differences were found in emergency department visits, hospitalizations, and mortality.
According to the researchers, most patients refilled their medications within 30 days of receiving a reminder, suggesting that the lack of long-term benefit may be related to 'intervention decay.' Michael Ho, co-principal investigator for Nudge, stated that "Additional interventions need to be rigorously tested to try to improve adherence to chronic cardiovascular medications."
Post hoc analysis showed modest improvement in refill adherence within the first three months after a refill gap when using text messaging strategies compared to usual care. The Nudge trial was supported by a grant from the National Heart, Lung, and Blood Institute within the NIH Pragmatic Trials Collaboratory.