Children’s hospitals leverage text messaging

By Molly Merrill
09:47 AM
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The devotion teenagers’ pay to their text messages may not be a bad thing, if children’s hospitals can use it to help boost medication adherence in their patients.

According to a 2010 report from the Pew Internet and American Life Project, half of teens send 50 or more text messages a day, or 1,500 texts a month, and one in three send more than 100 texts a day, or more than 3,000 texts a month.

Recognizing that text messaging was the primary mode of communication for her patients, Jennifer Dyer, MD, an endocrinologist at Nationwide Children's Hospital in Columbus, Ohio, developed the idea for a pilot that would use text messages to remind her teenage patients to take their insulin treatments.

Dyer reported seeing a trend in her patients that revealed most of them were missing nine to 11 boluses per week, or the majority of their insulin treatments.

By asking questions about glucose testing, meal boluses and frequency of high and low glucoses, Dyer said she saw an increase in teens taking their medications. After three months of sending text reminders she reported that they were three times less likely to miss a dose.

The successful outcome prompted Dyer to apply for an internal grant in order to test an iPhone application that she has developed. This application will allow endocrinologists to send personalized, automated texts to multiple patients at a specific time.

"This form of communication allows for real-time health management, which is extremely valuable for patients that suffer from a chronic illness like diabetes," said Dyer.

“This  [texting] can be used with every disease where the patients need to take medication on a regular basis,” agrees Tamir Miloh, MD, an assistant professor of pediatrics and surgery at Mt. Sinai Medical Center, who led a study on using text medication reminders to liver transplant patients.

The study, which was conducted by Mt. Sinai Medical Center's Pediatric Gastroenterology Department in 2008, found that as a result of receiving regular text alerts liver transplant patients were more likely to have higher adherence rates. The number of rejections dramatically decreased from 12 episodes the previous year to only two during the study.

The study used technology developed by CareSpeak Communications Inc., a privately held mobile health company in New Jersey. The technology is unique because it allows the physician to monitor the patient and also brings the patient’s caregiver in, by alerting them if the patient didn’t take their medication.
The study was so successful that half of the patients that participated in the study in 2008 are still in the program today, says Miloh.

Currently he says Mt. Sinai is working on a multi-center study involving text messages and adolescents that will involve five large transplant centers in the United States. And the hospital is now using the platform on a new initiative involving reducing obesity, says Serge Loncar, CEO of CareSpeak Communications.

The Pediatric Heart Transplant Program at NewYork-Presbyterian/Morgan Stanley Children's Hospital is also launching a one-year program that will use CareSpeak’s platform to increase medication adherence in its teenage heart transplant patients.

Transplant patients are required to follow very strict medication regimens to prevent their bodies from rejecting the “foreign object.” Patients often must take immunosuppressants every day, multiple times per day, for as long as they live. Failing to do so can result in hospitalization, the need for a re-transplant, and even death.

According to the journal Pediatric Transplantation non-adherence is the most common cause of organ rejection in long-term transplant patients, and adolescents are in the most high-risk category.

“Despite extensive educational programs for families and pediatric heart transplant recipients, significant medication noncompliance still occurs with alarming frequency, particularly with adolescents, which can prove deadly,” said Linda Addonizio, the director of the program for Pediatric Cardiomyopathy Heart Failure and Transplantation at NewYork-Presbyterian/Morgan Stanley Children’s Hospital. ”The outlook for long-term survival in non-compliant patients can be as low as 30 percent, compared to 90 percent survival in compliant pediatric heart transplant recipients.”

“Before this program, we had only the power of people trying to educate the children and their families about the deadly nature of noncompliance,” adds Addonizio. “Now we have the ability to give these adolescents a safety net to help them become responsible.”