EHR-Based Text, Call Reminders Show Promise for Medication Adherence

Patients considered electronic health record (EHR)-linked reminders for glaucoma medication useful when sent via text message or a phone call, potentially positioning the tech as a tool for medication adherence, according to a new study.

The study followed 100 participants, 94 of whom configured EHR reminders through a patient portal for three months. Of the 94 patients, 89 completed a follow-up questionnaire, and 66 patients (74 percent) found the reminders to be useful. Thirteen participants (11 percent) were neutral, while 10 (11 percent) found the reminders not useful.

Medication adherence is important to managing glaucoma, and non-adherence with glaucoma has been reported to range from 5 to 80 percent. One consistent factor of poor adherence is patients forgetting to use the medications. Based on the findings of a systematic review, electronic reminders, especially text message reminders, improve adherence to long-term medication regimens.

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Research head Varshini Varadaraj, MBBS, from Wilmer Eye Institute at Johns Hopkins University School of Medicine in Maryland, and her team designed and built a web-based application that allowed patients to access portions of their clinical data from MyChart or Epic Systems. The application also allowed medication reminders to be set up by patients through a patient portal linked to their EHRs. Patients got to choose their medication from a list in the EHR and decide when they wanted to be reminded and whether they wanted to be reminded by voice or text.

Patients who selected text-based reminders were prompted to use their eye drops and were supposed to respond to the reminder within 30 minutes. A second reminder was sent if participants didn’t respond within the 30 minutes, encouraging them to respond promptly. Those who received voice calls did not get additional messages.

Some participants chose to set up the reminders themselves, while others needed help from the researchers. It took researchers between five and 20 minutes to implement the system for each patient.

After the study, 42 participants (47 percent) said that they were very likely or likely to continue using the reminder. Ten participants (11 percent) were neutral, and 37 (42 percent) said they were very unlikely or unlikely to continue using the reminder.

The participants who said they would continue using the reminders were more likely to have 50 percent or higher probability of non-adherence compared with 2 percent among participants who did not want to continue.

Of the participants who would not continue using the reminders, 10 found no added benefit because they already had their own reminder strategies. Another 10 participants did not like responding to the reminders after administering their eye drops. Twenty participants complained about technical glitches with the system, including issues setting up the reminders, receiving extra reminders and getting reminders at the wrong time after changing to daylight saving time.

The majority of the participants (70) liked that the reminders were consistent, reliable, simple and succinct, and eight participants found the reminders especially useful on weekends and while traveling, when they would usually forget to take their medication. Five participants liked the accountability of having to respond to reminders after using their eye drops.

“These portals may represent a new and convenient method of allowing patients to link their glaucoma medications to automated reminders, although the generalizability of these results and the effect on glaucoma outcomes remains unknown,” the study authors concluded.

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