Quick Take: Text messaging turns the tide in pediatric compliance



A year-long study by Mt. Sinai Medical Centers Gastroenterology department with pediatric liver transplant patients finds that text message reminders help patients stay compliant with their anti-rejection medication regimen.

In a study of 41 young liver transplant recipients for whom medication was self-administered by either the patient or a caregiver, only two experienced a rejection episode while in the program, compared to 12 prior to use of the text messaging system.

The researchers reported at Digestive Disease Week in Chicago in early June that as many as 40% of adolescents with a liver transplant dont stick with their medication regimen and that it is the primary reason donor organs are rejected. In fact, in the year before the study, 49% of the patients showed drops in drug levels, putting them at risk for rejection.

The most common reported reason for non-adherence among young liver transplant patients is forgetfulness.

As part of the study, patients specified times at which reminders to take their anti-rejection medication would be texted to their cell phones or those of their caregivers. Patients then replied with a texted response indicating they had taken their medication or a second reminder was sent to their parent or caregiver. Levels of the drugs were measured in blood samples and after six months in the study, only 15% of the patients had dangerously low drug levels.

Improving compliance with medication is essential to improving long-term outcomes in pediatric transplant recipients, the researchers say, but current methods of improving adherence for chronic health problems are mostly complex and not very effective. Use of text messaging may prove effective, the group says, and is a behavioral support intervention that could be incorporated into routine clinical care, personalized and adapted to suit other chronic disease and age groups.

According to the researchers, 13 patients dropped out during the study, mainly due to cost, because families had to pay for the phones and text messaging. But even those patients showed improvements in compliance after taking part in the program.

We believe that during those six months, the behavior of adherence was learned, reinforced and then carried on even after they dropped out, the researchers said.

The group is applying for a grant to conduct a larger study in which cell phones and text services will be provided to patients.