# Interaction with SMS text-reminders correlate with improved medication adherence and readmission rates for congestive heart failure patients: A retrospective cohort study

## TL;DR

Personalized text message reminders helped heart failure patients remember to pick up their medications and reduced hospital readmissions.

## Contribution

Interactive SMS nudges with educational and coupon resources improve medication adherence and reduce readmissions in CHF patients.

## Key findings

- Patients who interacted with SMS nudges had 19% higher odds of filling prescriptions.
- These patients had 6% lower odds of hospital readmission within 30 days.
- The effect was strongest among previously readmitted patients, with a 10% increase in prescription fill rates.

## Abstract

Short message service text reminders (SMS nudges) aimed to help vulnerable patient populations remember to fill their prescriptions are becoming more common but accurately measuring their effects on improving prescription fill and readmission rates remains challenging. Patients who presented to the emergency department (ED) with a primary diagnosis of congestive heart failure (CHF) were included in the study. We conducted a retrospective cohort study of CHF patients who did and did not interact with SMS nudges, then matched patients who were prescribed medications at any point in their hospital visit with records of subsequent prescription fills. Patients that interacted with SMS nudges had 19% higher odds of filling prescriptions overall (1.19 OR (95% CI: 1.15 – 1.24), p < 0.001) and 6% lower odds of being readmitted to the hospital (0.94 (95% CI: 0.9 – 0.99), p = 0.009) than patients who did not interact with SMS nudges. Interactive SMS nudges via a novel tool may improve prescription fill rates across multiple groups of CHF patients, and contribute to a reduction in readmissions.

When patients leave the hospital with new prescriptions, many never fill them. A problem that can lead to worsening symptoms and costly hospital readmissions. We wanted to investigate if personalized text message reminders could help patients remember to pick up their medications after being hospitalized for heart failure. We studied over 1,200 heart failure patients at a rural hospital who received text messages reminding them about their prescriptions. These weren’t just simple reminders. Patients could click a link to see which medications were waiting, watch educational videos, and access coupons to reduce costs. Our findings suggest that patients who engaged with these text reminders were more likely to pick up their prescriptions and less likely to return to the hospital within 30 days. The effect was strongest among patients who had been readmitted. Those who clicked on the reminder increased their prescription fill rates by nearly 10 percent. Our results suggest personalized SMS-text reminders may be a simple, scalable tool to help vulnerable patients manage their medications. This matters because even small improvements in medication adherence could prevent emergency room visits and hospitalizations, ultimately improving patients’ quality of life.