A pilot program that uses text message medication reminders has led to reduced asthma exacerbations and fewer hospitalizations among participating inner-city adolescents.
The CDC notes that “epidemiologists and clinical researchers have known for some time that the burden of asthma is especially great in urban areas with high levels of poverty and large minority populations. This is evidenced by the greater frequency of severe asthma episodes that lead to hospitalization or death.”
According to Humaa M. Bhatti, DO, the asthma burden among African American adolescents in inner-city Detroit is particularly high, due to a variety of socioeconomic factors and high rates of non-adherence to treatment. During a presentation at the 2014 Annual Meeting of the American Academy of Allergy, Asthma & Immunology, held February 28 — March 4, 2014, in San Diego, CA, she told the audience that the population of the city of Detroit is 82% African American, with high rates of poverty and poor education performance. One-third of the population is under 18 years of age.
She also said Detroit’s rate of hospitalization due to asthma complications is much higher than the national average, asthma-related emergency room visits in the city are 50% higher than in the state as a whole, and deaths from asthma are a staggering 5.4 times higher in Detroit than in the rest of Michigan.
Bhatti said that non-adherence to asthma medication regimens is a persistent problem among these patients. Against this somber background, she and her colleagues examined the effects on asthma control of sending medication reminders to patients and allowing them to communicate with research staff via text messaging.
Researchers enrolled 37 patients (up to 18 years old) in the study after obtaining informed consent from participants and their parents. Of this cohort, 29 completed 3-9 months of the study. One or more steroid medications were used by 21 subjects, and 28 of 29 required at least one urgent care visit during the study.
Text reminders were sent twice daily by a research assistant to the parents and/or teenage patients with the understanding that patients should receive medication upon receipt of reminders. The eight dropouts were mostly due to the participants either finding the texting annoying or the predetermined timing of the messaging (7:00am and 7:00pm). The latter was later modified to accommodate individual patients’ needs.
Rates of asthma exacerbations, requiring prednisone administration, were significantly reduced during the study, especially if extrapolated to 12 months, and hospitalizations were lower by the end of the study (p=0.001).
The results suggest that communicating with these patients via text reminders effects positive change on control of their asthma.
Bhatti said 25 additional patients have been added to the program since November 2013. As the numbers of participants increases, the introduction of automation into the texting process and the possible incorporation of an element of randomization are receiving increasingly serious consideration.