ORLANDO, Fla. — Medication adherence improved among young asthma patients who received tailored reminders through automated speech or text messaging systems, according to two studies presented during the American Academy of Allergy, Asthma & Immunology 2012 Annual Meeting.
In one study, researchers used a speech recognition reminder system to automatically call pediatric patient families with an option to initiate rapid inhaled corticosteroid (ICS) refills or speak to nurse specialists. The other study targeted adolescents with randomly generated asthma education text messages for 30 days.
Speech Recognition Reminders
In a study funded by the National Heart Lung and Blood Institute, researchers set up intervention and control groups among 1,393 children between the ages of 3 and 12 years with persistent asthma. Up to three tailored speech recognition reminders were provided to the intervention group when individuals were due to refill their ICS prescriptions. The reminder calls also provided asthma information, rapid ICS refills and the option for callbacks from an asthma nurse specialist.
The intervention group recorded a shorter time to first ICS refill (median 52 days) compared with control (median 78 days) (HR=1.26; 95% CI, 1.12–1.42). The intervention group also had medication on hand for a greater proportion of days, compared with control (38% vs. 28%, P<.0001).
“There was a lot of thinking behind this,” Peter Cvietusa, MD, the study’s lead investigator and co-chair of Kaiser Permanente’s Asthma Implementation Resource Group in Colorado, said. “It is a ‘robo call’ … but it’s in a system that was heavily supported through asthma care managers, and we try to make it easy to direct [patients] to a mail-order pharmacy. You could do this in a private practice, but unless you have those support structures in place, it might not work quite as well.”
Cvietusa said focus groups were tapped prior to the study to gauge what parents would accept because automated calls have a built-in risk of annoyance.
The calls were tailored to seasonality, with patients receiving a “basic call,” then a “tardy call” and finally a “personal call” if they did not adhere to their regimen. The personal call is “like getting called to the principal’s office,” Cvietusa said. “And half the patients got that call.”
The study concluded that a similar speech recognition system can be implemented in a large HMO to positively influence medication adherence.
Text Message Reminders
A separate pilot study funded by National Jewish Health of Denver, concluded that adolescents with asthma readily accepted text messaging about medication adherence; 93% of patients believed it benefitted their care.
The brief study enrolled 43 adolescents with asthma between the ages of 12 to 17 years in a randomized, prospective, controlled trial that utilized the subjects’ own personal cellular phones and short message service (SMS) plans. Subjects received randomly generated text messages pertaining to asthma education at variable frequencies (once every other day to twice per day) for 30 days.
Researchers found that 86% liked receiving the asthma messages and only 7% felt they received too many messages. Study adolescents reported higher adherence (P=.045) and confidence (P=.01) with their asthma care.
“Younger kids tend to do better because the parents are on top of them. Teenagers want more autonomy; the parents are not on top of them … and they all text non-stop,” said researcher Daniel A. Searing, MD, from the division of allergy and Immunology, department of pediatrics at National Jewish Health, Denver. “We wanted to see: Are kids responsive to it and do they like it?”
Searing, assistant professor in the Department of Pediatrics for National Jewish Health, said the text messages to patients included reminders to take their medication, educational pointers; and related links to Facebook pages and YouTube videos.
Patients who indicated issues with adherence were sent reminders that explained why taking their asthma medication is important to their care, Searing said.
The researchers now want to do a longer 6-month to year-long study to determine if text messages reminders actually improve asthma outcomes.
“Yes, kids like it. But does it actually help?” Searing said.
- Dr. Cvietusa and Searing report no relevant financial disclosures.