Randomised trial of text messaging on adherence to cardiovascular preventive treatment (INTERACT trial)

David S Wald, Jonathan P Bestwick, Lewis Raiman, Rebecca Brendell, Nicholas J Wald, David S Wald, Jonathan P Bestwick, Lewis Raiman, Rebecca Brendell, Nicholas J Wald

Abstract

Background: About one third of patients prescribed blood pressure or lipid-lowering drugs for the prevention of coronary heart disease and stroke do not take their medication as prescribed. We conducted a randomized trial to evaluate text messaging as a means of improving adherence to cardiovascular disease preventive treatment.

Methods: 303 patients taking blood pressure and/or lipid-lowering medications were randomly assigned to being sent text messages (Text group, 151) or not being sent them (No text group, 152). Texts were sent daily for 2 weeks, alternate days for 2 weeks and weekly thereafter for 22 weeks (6 months overall), using an automated computer programme. Patients were asked to respond on whether they had taken their medication, whether the text reminded them to do so if they had forgotten, and if they had not taken their medication to determine if there was a reason for not doing so. At 6 months, use of medication was assessed.

Results: Two patients were lost to follow-up, providing data on 301 for analysis. In the No text group 38/151 (25%) took less than 80% of the prescribed regimen (ie. stopped medication completely or took it on fewer than 22 of the last 28 days of follow-up) compared to 14/150 patients (9%) in the Text group - an improvement in adherence affecting 16 per 100 patients (95% CI 7 to 24), p<0.001. The texts reminded 98/151 patients (65%) to take medication on at least one occasion and lead to 20/151 (13%) who stopped taking medication because of concern over efficacy or side-effects, resuming treatment.

Conclusions: In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular disease, text messaging improved medication adherence compared with no text messaging.

Trial registration: Controlled-Trials.com ISRCTN74757601.

Conflict of interest statement

Competing Interests: David Wald has read the journal's policy and the authors of this manuscript have the following competing interests: Nicholas Wald jointly holds US, European and Canadian patents (EU1272220 priority date 10 April 2000) for a combination pill for the prevention of cardiovascular disease and together with David Wald is a shareholder in Polypill Ltd. Astra Zeneca part-funded the INTERACT trial. None of these disclosures alter the authors' adherence to all PLOS ONE policies on data sharing and materials.

Figures

Figure 1. Trial Flow Diagram.
Figure 1. Trial Flow Diagram.

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