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Reminders tied to life, calendar events fail to increase medication adherence
Researchers tested medication reminders linked to “fresh-start” dates, defined as life and calendar events indicating the start of new cycles such as a birthday or New Year’s Day, and found no increase in medication adherence.
“Contrary to our expectations, sending reminders following fresh-start dates was not associated with increased medication adherence, and fresh-start-based framing was not associated with increased reminder effectiveness. We encourage further study before concluding that the psychology of fresh starts does not apply to medication adherence. Because fresh-start dates motivate individuals wishing to initiate goal pursuit, our timing- and framing-based treatments may increase the effectiveness of reminders when reminders involve goal-setting activities,” Hengchen Dai, PhD, of the Olin Business School at Washington University in St. Louis, and colleagues wrote in a research letter published in JAMA Cardiology.
Reminders sent
Reminders to take cholesterol, diabetes or BP medications regularly were mailed to 13,323 participants (45% men) between Jan. 21 and March 25, 2015. The patients exhibited 40% to 80% medication adherence in the past 12 months, and all patients had commercial or Medicare Advantage insurance with Humana. Patients were randomly assigned to one of five groups (controls, birthday framed, birthday unframed, new year framed and new year unframed).
“In the birthday unframed and birthday framed conditions, reminders were sent within 1 week before each participant’s birthday. In the new year unframed and new year framed conditions, reminders were sent 3 weeks after New Year’s Day. Reminders in the birthday framed and new year framed conditions highlighted the participants’ birthday or New Year’s Day, respectively, as an opportunity to make a fresh start and begin taking medications regularly. In the control condition, reminders without any reference to fresh start dates were sent on a randomly selected day that was at least 1 month after New Year’s Day and 1 week away from the participant’s birthday,” the researchers wrote.
Pharmacy claims data were used for calculating the proportion of days covered for each patient during a 90-day postmailing observation period. This was defined as “the number of days he/she had any pills in the medication category listed on his/ her reminder divided by 90 days.”
No effect seen
Dai and colleagues found no significant difference in the proportion of days covered between the controls and either the birthday unframed group (mean difference, 0.56%; 95% CI, 1.09 to 2.19) or the birthday framed group (mean difference, 0.55%; 95% CI, 1.08 to 2.2). Similarly, no significant difference in the proportion of days covered was found between the controls and either the new year unframed group (mean difference, 1.32%; 95% CI, 0.32 to 2.95) or the new year framed group (mean difference, 0.38%; 95% CI, 1.26 to 2.03).
There was also no difference in the proportion of days covered between the birthday framed group and the birthday unframed group (mean difference, –0.02%; 95% CI, 1.66 to 1.63), as well as between the new year framed and new year unframed group (mean difference, –0.93%; 95% CI, 2.57 to 0.71).
“Reminders received immediately after the target date could be more effective. Further investigation into alternative ways to leverage fresh starts and compel patients to attend to public health messaging would be valuable,” Dai and colleagues wrote. – by Suzanne Reist
Disclosure: The study was funded by research grants from Humana. Dai reports receiving funding in part by grants from Humana during the conduct of the study. Please see the full study for a list of the other researchers’ relevant financial disclosures.