Automated Texts, Other Tech Interventions May Improve Psychiatric Drug Adherence

Telemedicine interventions may improve medication adherence in patients with bipolar disorder, depression, and schizophrenia, according to a systematic review published in General Hospital Psychiatry. 

“Telemedicine interventions for adherence have the advantage over face-to-face interventions of addressing the nonadherence when and where it occurs (eg, in between visits and outside of the pharmacy/clinic),” researchers wrote. “This systematic review explored and categorized the literature of randomized controlled trials of telemedicine interventions for medication adherence in people with depression, bipolar disorder, and schizophrenia.” 

Seventeen studies were included in the review. Three involved telemedicine interventions deemed low intensity: an automated smartphone reminder app and automated text messages. Three medium-intensity studies used automated text messages and a combination of telemonitoring and phone interventions. The remaining 11 high-intensity studies used phone and online messaging interventions that required ongoing staff involvement in monitoring, problem-solving, psychoeducation, and adherence counseling. Overall, phone technology was the primary intervention in every study except one. 

Telemedicine interventions demonstrated efficacy for improved adherence in nine studies, researchers reported. Positive outcomes occurred in the majority of the low- and medium-intensity studies, although less than half of the high-intensity studies were positive. 

The reasons behind nonadherence—whether practical and unintentional, or belief-driven and intentional—will influence the effectiveness of interventions intended to promote adherence, researchers noted. 

“Future studies are needed,” they wrote, “to better understand how technology can be tailored to different types of nonadherence.” —Jolynn Tumolo