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Medication Adherence

Medically reviewed by Susan Kerrigan, MD and Marianne Madsen on February 2, 2023
Additions/comments provided by Surya Singh, MD

The only thing worse than a disorganized day-of-the-week pill organizer is forgetting to refill a prescription. Running out of medication isn’t just an inconvenience. For some, it’s a matter of life or death.


Few things are as aggravating as the last-minute refill. In the olden days––like the late 1990s––this meant phone calls, driving, parking, and waiting in an interminable line. In an age of online refills and even delivery, it’s hard to believe many people still do this. Yet whether you’re an online or in-person orderer, there are tools available. One-way refill reminders, order status messages, and two-way clinical messaging are all designed to help you manage your prescriptions. The question is, do they actually work?


Getting the message


Text messaging’s popularity exploded during the early years of the 21st century. It’s easy to see why. Texting lets people connect while doing something else. Less intrusive than a phone call, texts offered one-way refill reminders for everyone from older homeowners to homeless vets. In fact, for many people the mobile phone is now their only phone. Today, even most homeless adults in the U.S. have a mobile phone.

Homeless vets in one Boston-based study were open to receiving health-related communications. Perhaps not surprisingly, they were more accepting of texts than phone calls. Their main worry was reminder calls eating up more minutes than texts on their prepaid accounts. Today, most people prefer texts to phone calls. They are less demanding than a ringing phone and can be read at the receiver’s convenience.


In the U.S., patients are protected by the Health Insurance Portability and Accountability Act of 1996. According to Health and Human Services, “The Privacy Rule gives individuals important controls over whether and how their protected health information is used and disclosed for marketing purposes.” There are exceptions, including “communications about refill reminders and other communications about a drug or biologic currently being prescribed to the individual (“refill reminder exception”).” Texts trying to get you to change medications or try a new one are not permitted.

Texts even help patients who already have their own reminder systems. In South Africa, one study looked at people receiving high blood pressure treatment. It showed that they appreciated a respectful tone along with respectful timing and frequency of the message. They liked feeling cared for. Those who had struggled with their treatment regimen due to stress benefited the most from reminder texts.


For over a half century, study after study has demonstrated that often the greatest barrier to a patient’s health is the patient themself. From hypertension to leukemia, not remembering to take medication has clear consequences. With specialty pharmaceuticals, the challenge is magnified by the drug’s rarity and cost. One-way text messages improved adherence to treatment regimens. Order status messages let patients know exactly how long it would be before a prescription was available.

Unfortunately, reminders may not be enough. Electronically measured medication usage eliminates the tendency most of us have to put our best foot forward. Instead of asking if a patient took his or her medication, the health care provider already knows. This opens the door to addressing any underlying issues.


By the second decade of the 21st century, smartphones had replaced “dumb phones.” Internet access became widely available across the globe. Yet email reminders are even more likely to be ignored than phone calls. So many health care providers introduced two-way clinical messaging. By requiring a patient response, the system motivates clients to make sure their prescription is refilled on time. Clinical secure messaging is harder to ignore. A study of chronic myeloid leukemia patients found greater adherence for those using two-way clinical messaging in addition to one-way refill reminders and order status messages than to those not using it.


Whether it’s no tech or new tech, it’s never going to be easy to always remember to refill your prescription. Life often gets in the way. Thankfully, there are tools both new and old to make it all a bit easier.


Written by John Bankston

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