Higher ADHD Treatment Adherence Rates Linked to Text Message Intervention

Joseph Bierderman, MD

While stimulant treatment decreases the risk of adverse outcomes in patients with attention-deficit/hyperactivity disorder (ADHD), treatment compliance is poor, according to new data.

A team, led by Joseph Biederman, MD, Massachusetts General Hospital, examined if text message reminders could be effective in adherence to ADHD stimulant medications in both children and adults.

The findings were presented at the American Psychiatric Association Annual Meeting.

Study

The study included adults ages 18 – 55 years old and children aged 6 – 12, diagnosed with ADHD and prescribed stimulant medication. They were recruited for text message intervention after approval from their prescriber.

The team noted that text messages were sent 4 times a week to parents of children with ADHD and 2 times a day to adult subjects with ADHD.

Text messages included reminders to take prescription at time prescribed, medication refill reminders, education about ADHD, and education about prescription medication. Other text messages included tips on time management, morning routine, relationships, stress, and sleep.

A comparator data set was selected from the Partners HealthCare Electronic Medical Records (EMR) of patients who had been prescribed stimulant medication in the same time frame.

Then, the team used logistic regression to compare rates of adherence between the text messaging group and patients receiving normal treatment.

Investigators determined patient’s refill timeliness using the prescriptions documented in the EMR for each patient.

If the stimulant prescription was issued within 37 days of the start data of text messages or 37 days of the index prescription for the EMR group, a patient was considered adherent.

Results

The data included 92 adult text messaging intervention patients, with an average age of 32.7 years, 61% male and 92% White. The usual care adult patients included 460 adults, with an average age of 31.5, 61% male, and 82% White.

In the child study, 82 children were included in the text messaging intervention, with an average age of 9.2 years, 75% male, and 79% White. The children in the usual care included 261 patients, with an average age of 9.4 years, 75% male, and 79% White.

Investigators found in both the adult and children group receiving text message intervention, the adherence rate was double the comparators receiving treatment as usual.

In the adult group, 68% of patients in the text messaging group adhered to stimulant treatment, compared to 34% in EMR usual care (OR 4.04; 95% CI, 2.49, 6.56, p < .001).

In the children group, 85% of patients adhered to stimulant treatment, compared to 42% in EMR usual care (OR 4.04; 95% CI, 2.49, 6.56, p < .001).

The team noted that based on an NNT = 3, for every three patients, they could keep 1 engaged in the stimulant treatment.

Conclusion

Investigators concluded the data supported the use of an ADHD-centric text messaging intervention in both children and adults with ADHD.

“These findings provide strong support for the utility of this readily accessible, inexpensive, and widely available technology to improve the poor rate of adherence to stimulant treatment in clinical practice,” investigators wrote.

The study, “A Novel SMS Intervention to Improve Adherence to Stimulants in Children and Adults With ADHD,” was published online by the American Psychiatric Association.