Impact of Texting and Predictive Potential of Health Literacy on Medication Adherence in T2DM
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Abstract
Background
Poor medication adherence (i.e., failure to take the proper medication at the correct time) is a causative factor for diminished control of type 2 diabetes mellitus (T2DM). Poor adherence is also correlated with an increased incidence of vascular, nephrologic, neurologic and ophthalmological complications as well as a higher cost burden. One of the chief culprits for suboptimal adherence is patients’ inability to recall and act upon their dosage regimens. Other variables associated with a lack of adherence in T2DM include socioeconomic status, ethnicity (e.g., Hispanics), and low health literacy. Low health literacy is also significantly associated with hypoglycemic episodes. Due to the high penetration of mobile phones across socioeconomic groups and the extremely high read rate (94%) for mobile SMS (short message service), text message medication reminders offer a promising intervention for improving medication adherence in T2DM patients.
The primary objective of this study is to improve medication adherence in patients with T2DM via use of daily SMS medication reminders. Secondary objectives include: 1) to assess health literacy levels in an ethnically diverse, uninsured/underinsured patient population, 2) to examine the predictive potential of measured health literacy and disease knowledge for medication adherence, and 3) to perform a test-retest with health literacy and disease knowledge assessment tools.
Methods
A randomized, open-label, controlled study is being conducted at a primary care clinic with a diverse, underinsured /uninsured patient population in the USA. The intervention is a daily SMS medication reminder temporally-selected by participants and including the disease and medication de-identified text message, "It's that time". Text selection was chosen to be consistent with previous research and ethics board requirements. Participants will be randomized to either the SMS + standard care (intervention) group or standard care alone (control) group for 6 months. Baseline data, including HbA1C, demographics, and medication regimens will be collected for all patients at the initial visit. Other measures employed at baseline and month 6 in this study include health literacy via the REALM-SF (Rapid Estimate of Adult Literacy in Medicine – Short Form) instrument and disease knowledge with the DKT (Disease Knowledge Test) – T2DM subset tool to allow for test-retest validation. Medication adherence will be assessed at months 3 and 6 via pharmacy refill records, electronic health record (EHR) data, the MMAS (Morisky Medication Adherence Scale) and measured by hemoglobin A1C (HbA1C). REALM-SF and DKT-T2DM scores will also be introduced into the EHR for future visits and targeted diabetes education scheduling. In the intervention group only, a brief questionnaire will be administered to assess satisfaction and evaluate SMS alert fatigue at months 3 and 6. Inferential statistical tests will be used to assess the effect of SMS on adherence. Multivariable linear regression will be used to explore associations between health literacy and clinical outcomes (e.g., HbA1C).
Results
Research in progress.
Conclusions
Research in progress.
Poor medication adherence (i.e., failure to take the proper medication at the correct time) is a causative factor for diminished control of type 2 diabetes mellitus (T2DM). Poor adherence is also correlated with an increased incidence of vascular, nephrologic, neurologic and ophthalmological complications as well as a higher cost burden. One of the chief culprits for suboptimal adherence is patients’ inability to recall and act upon their dosage regimens. Other variables associated with a lack of adherence in T2DM include socioeconomic status, ethnicity (e.g., Hispanics), and low health literacy. Low health literacy is also significantly associated with hypoglycemic episodes. Due to the high penetration of mobile phones across socioeconomic groups and the extremely high read rate (94%) for mobile SMS (short message service), text message medication reminders offer a promising intervention for improving medication adherence in T2DM patients.
The primary objective of this study is to improve medication adherence in patients with T2DM via use of daily SMS medication reminders. Secondary objectives include: 1) to assess health literacy levels in an ethnically diverse, uninsured/underinsured patient population, 2) to examine the predictive potential of measured health literacy and disease knowledge for medication adherence, and 3) to perform a test-retest with health literacy and disease knowledge assessment tools.
Methods
A randomized, open-label, controlled study is being conducted at a primary care clinic with a diverse, underinsured /uninsured patient population in the USA. The intervention is a daily SMS medication reminder temporally-selected by participants and including the disease and medication de-identified text message, "It's that time". Text selection was chosen to be consistent with previous research and ethics board requirements. Participants will be randomized to either the SMS + standard care (intervention) group or standard care alone (control) group for 6 months. Baseline data, including HbA1C, demographics, and medication regimens will be collected for all patients at the initial visit. Other measures employed at baseline and month 6 in this study include health literacy via the REALM-SF (Rapid Estimate of Adult Literacy in Medicine – Short Form) instrument and disease knowledge with the DKT (Disease Knowledge Test) – T2DM subset tool to allow for test-retest validation. Medication adherence will be assessed at months 3 and 6 via pharmacy refill records, electronic health record (EHR) data, the MMAS (Morisky Medication Adherence Scale) and measured by hemoglobin A1C (HbA1C). REALM-SF and DKT-T2DM scores will also be introduced into the EHR for future visits and targeted diabetes education scheduling. In the intervention group only, a brief questionnaire will be administered to assess satisfaction and evaluate SMS alert fatigue at months 3 and 6. Inferential statistical tests will be used to assess the effect of SMS on adherence. Multivariable linear regression will be used to explore associations between health literacy and clinical outcomes (e.g., HbA1C).
Results
Research in progress.
Conclusions
Research in progress.
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