Can EHR-Based Text Reminders Improve Patient Medication Adherence?
Abena Ansah-Yeboah  |  August 5, 2019
Researchers from Wilmer Eye Institute at Johns Hopkins conducted a cross-sectional study following 94 glaucoma patients over the course of 3 months. Participants agreed to configure electronic health record (EHR) reminders through a patient portal to receive notifications via text or voice call to take their appropriate medications. The purpose of this study was to measure the impact of telecommunication-based automated reminder systems on patient drug adherence. Glaucoma patients, in particular, served as an ideal study group, because although medication adherence is critical to managing the progression of this disease, non-adherence ranges anywhere between 5 to 80%. One major factor related to poor adherence is forgetfulness, and by linking dosing reminders to each patient’s EHR information, the research team hoped to improve patient adherence to long-term medication regimens.
Each patient was given access to a web-based portal connected to either MyChart or Epic Systems, selected the appropriate medications, and chose when (time of day) and how (voice call or text message) they preferred to receive reminders. Participants who chose the text-based option were prompted and required to respond within a 30-minute window with a second reminder sent if they did not reply. Those who chose to receive reminders through voice calls were phoned only once with no follow up messages. The main outcomes investigators sought to measure were (1) the proportion of patients willing to continue using the system and (2) overall patient satisfaction with the system. Results showed the following:
  • 74% of participants found the reminder system useful.
    • 15% of participants were neutral.
    • 11% of participants did not find the reminder system useful.
  • 78% of participants liked that reminders were simple, consistent, and reliable.
    • 9% of participants found reminders useful on weekends and while traveling.
    • 5% of participants liked accountability of having to respond to reminders after taking medication.
  • 47% of participants stated likely or very likely to continue using reminder system.
    • 11% of participants were neutral.
    • 42% of participants stated unlikely or very unlikely to continue using reminder system.
With almost three-quarters of participants finding the reminders beneficial, it is safe to conclude that such patient portals may serve as a new and convenient means of sending automated reminders to improve adherence to glaucoma medications. It is important to note, however, that a large proportion of participants (42%) claimed they were not likely to utilize the reminder system in the future. Of those who responded this way, 10 patients did not like having to respond to the reminders after taking their eye drops while another 10 found no added benefit because they already followed their own reminder strategies. Across all subjects, at least 20 participants complained of technical issues regarding difficulties setting up reminders or receiving reminders at the wrong time. Before expanding this EHR-linked reminder system, it will be important to not only iron out all outstanding technical glitches, but determine which glaucoma patient populations are at high risk for poor adherence and how they can effectively be targeted. Future research assessing the long-term effect on glaucoma outcomes as well as the generalizability of these results to other disease populations would be useful to understand the extent to which this reminder system model can improve overall disease management.