Text messaging has earned a reputation as ruinous for young folk: deleterious to their manners, corrosive to their literacy level and potentially deadly while they’re driving.
But, as some doctors discussed during a recent grand rounds at Johns Hopkins Center’s Children’s Hospital in Maryland, text messaging can increase the response rate from patients who need the most monitoring – those with asthma, HIV/AIDS, diabetes or recent transplants.
For these patients, taking medications regularly and on time can mean the difference between life and death.
The problem is that teens so often don’t check their voicemail, can’t be bothered to go through the multi-step process of paging their doctor and, because of a youthful “feeling of invincibility,” don’t remember to take their medications, said Dr. Delphine Robotham, a pediatric resident with the hospital.
Text message alerts and reminders, whether sent about making appointments or taking medications, seemed to bridge that gap.
“When I did some more research I found it had been used with quite a bit of success in several different diseases – and all the information was really new, mostly from past couple of years,” Robotham said.
Intrigued, Robotham led the grand rounds discussion last month by examining the recent literature done on the subject. In a 2008 study involving diabetes patients, more than a third provided their glucose readings — via texting — without being reminded. In a 2009 study on asthma patients, text reminders to take medication increased adherence from an average of 77.9% to 81.5%, while adherence in a control group that didn’t receive texts decreased from 84.2% to 70.1%. That’s a 17.8% absolute difference between the two groups.
There are some barriers to implementing a text-messaging system, physicians at the grand rounds pointed out. Doctors tend to use their pagers rather than cellphones, and patients must own their own cellphone (and must agree to certain waivers of privacy). Who pays for text messaging –the hospital or the patient or the insurance plan? -- is unclear. Building an automated system could cost tens of thousands of dollars. Having a real person in charge of texting patients individually could be expensive as well.
Still, Robotham said, texting has such untapped potential for adolescents in the healthcare system that the idea is worth further study.
“Every patient is different and has [his or her] own reasons for difficulty with making appointments and things like that,” Robotham noted in an interview. But, she added, “something that could be put into use to increase compliance in any patient is just huge.”
-- Amina Khan