February 1, 2010

DID U TK UR MEDS? Texting can improve care of patients

From a lethal distraction for drivers to dehumanizing personal interactions, text messaging has gotten a bum rap lately. But for doctors treating patients with chronic diseases, text messaging can be an invaluable tool, according to Johns Hopkins Children’s Center pediatrician Delphine Robotham. “For better or worse, this technology is here,” she said, “and sending a text to a patient’s cell phone about an upcoming appointment or a test, or simply to remind them to take their meds, is a great example of how we can harness new communication technology for a greater good.”

Research has shown that up to half of patients may fail to take their daily medication properly, with forgetting being a top reason for nonadherence so, at least in some cases, a text reminder may be all that a patient needs, added Robotham, who has encouraged the use of appropriate texting among pediatricians at Johns Hopkins.

Several recent studies have looked at use of SMS (short message service, or text messaging) in a medical context, Robotham notes. For example, one study involving children with diabetes showed improved blood glucose testing rates among those using it. These children were also more likely to share their blood glucose test readings with their doctor’s office. In another study, patients on immunosuppressive drugs after a liver transplant had improved medication adherence. The liver study detected measurable clinical benefits from text messaging: Acute liver rejection episodes dropped dramatically as a result of better medication adherence. Chronic conditions that require daily medication, such as HIV, asthma and TB, or daily testing, such as diabetes, are great candidates for “SMS therapy,” Robotham said.

Johns Hopkins Children’s Center tuberculosis expert Sanjay Jain understands all too well the challenges of getting patients to follow months-long drug regimens.

“Texting is an even more popular mode of communication outside the United States, and especially so in developing countries, where most of the TB cases are, so I could see this being a great new way to reach those hard-to-reach patients,” Jain said.

The Johns Hopkins Children’s Center may soon formalize the use of this technology with teen health expert Maria Trent designing and hoping to launch a pilot study using text-message reminders for patients with pelvic inflammatory disease. Treatment involves several weeks of antibiotics and requires that all patients come back for retesting after finishing their medication.

Pediatric HIV expert Allison Agwu has been using texts to remind her patients of follow-up appointments and has seen good response. She also is preparing to launch a formal study. The reasons behind the growing social popularity of text messaging are manifold and complex, but Robotham and colleagues said they believe that SMS use in the medical setting will soon catch up.

“Why wouldn’t it?” Robotham said. “A patient can read a text instantly and respond unobtrusively. It doesn’t require Internet access or picking up the phone in the middle of class or an important meeting. Sometimes, I call patients and I get no response, but when I text, I get a response immediately.”

Pediatric specialists as well as primary-care pediatricians should not overlook SMS technology, the Johns Hopkins researchers said, but there are caveats: Texting is not a substitute for all communication, it could be expensive, and it doesn’t always ensure reaching a patient who may have changed her number or lost her phone. “It won’t be a silver bullet, but it could certainly be a nice little tool in an arsenal of many other tools,” Robotham said.