Nudge

Taking Text Messaging to scale to support cardiovascular medication adherence
Up to 50% of patients do not take their cardiovascular (CV) medications as prescribed, and interventions (e.g. patient education, reminders, pharmacist support, financial incentives), have produced mixed results. Brief behavioral interventions help influence human behavior and decision-making. Principles of behavioral economics have been incorporated into behavioral health interventions to “nudge” people to improved health outcomes, such as a study testing financial incentives through elimination of copayments for cardiovascular medications after acute myocardial infarction improving adherence by 4 to 6%. The increasing attention to the use of mobile and digital technologies for health promotion and disease self-management offers an intriguing but untested opportunity to adapt behavioral nudges using ubiquitous cell phone technology to facilitate medication adherence. In this project funded by the National Heart Lung and Blood Institute, the University of Colorado School of Medicine and mHealth Impact Lab are partnering with three large healthcare delivery systems—Denver Health and Hospital Authority, the Veteran’s administration, and University of Colorado Health. We will leverage their pharmacy refill data to identify patients with gaps in medication refills and test multiple automated approaches using text messaging and an artificially intelligent chat bot to identify and resolve barriers to refill and adherence. Our findings from this work will offer insights on how to automate and deliver effective text messages at scale through large healthcare delivery systems, thereby increasing their impact at a population level.