Journal Club: Text messaging improves medication adherence in transplant patients

Text message reminders significantly improved adherence to medication regimens in pediatric orthotopic liver transplant patients, according to a recent report. The 13-month prospective study was conducted in 41 patients from 1 to 27 years of age (median age, 15 years). Investigators sent patients or their caregivers (depending on who administered the medication) medication alerts at selected, specified times via text messages. The recipient was instructed to confirm when the patient took the medication; if he or she was the patient and failed to respond, investigators sent the caregiver another message.

Investigators compared serum medication levels for the year before and the year of the study (blood samples were drawn every 1 to 2 months) and calculated and compared standard deviations (SDs) for the immunosuppressant tacrolimus. A higher SD suggested that medication was being taken less consistently, and hence there was lower adherence. Before study participation, the mean tacrolimus level SD was 3.46 mcg/L, decreasing to 1.37 mcg/L after participation. How many immunosuppressants the patient took and whether the patient or the caretaker administered them did not significantly affect results.

Six patients continued to have tacrolimus level SD values of more than 2.5 mcg/L-the level associated with rejection episodes-after the intervention. Nonetheless, acute cellular rejection episodes decreased from 12 to 2 during the study. Risk factors for rejection were older age and administration of more than 1 immunosuppressant (Miloh T, et al. Pediatrics. 2009;124[5]:e844-e850).

If you have a teenager in the house, you know that nothing gets his or her attention like the phone signaling the arrival of a new text message. Like most patients, those described here cited lapse of memory as the chief reason for not adhering to medication regimens. Congratulations to these researchers for using technology that is always at hand to address patient forgetfulness. This intervention makes sense for both chronic and acute medication administration.-MB