'Fresh start' reminders may not increase medication adherence

Sending reminders around fresh start dates did not increase medication adherence among patients who were prescribed cholesterol, diabetes or blood pressure medications, according to a randomized trial.

The researchers defined fresh start dates as those such as birthdays or New Year’s Day that signaled the beginning of a new cycle.

Lead researcher Hengchen Dai, PhD, of the Olin Business School at Washington University in St. Louis, and colleagues published their results online in JAMA Cardiology on Feb. 8.

The study included 13,323 participants who had commercial or Medicare Advantage insurance through Humana. The researchers sent them reminders between Jan. 21, 2015, and March 25, 2015, to take their cholesterol, diabetes or blood pressure medications.

The participants were randomized to one of five groups. The birthday unframed and birthday framed groups received reminders within a week before their birthday, while the new year unframed and new year framed groups received reminders three weeks after New Year’s Day. The control group received reminders on random dates that were at least one month after New Year’s Day and one week after from their birthday.

The framed groups received reminders that told them to make a fresh start and begin taking their medications regularly.

During the 90-day postmailing period, the mean proportion of days covered was 63.3 percent. The proportion of days covered were similar in each of the five conditions and ranged from approximately 62.7 percent in the control group to approximately 64 percent in the new year unframed group.

The researchers mentioned the study had a few limitations, including that Humana sent some customers medication adherence reminders outside of the trial. Many of the participants were also involved in another randomized trial comparing reminders that ended shortly before this one began. In addition, they noted that participants in this study had lower medication adherence levels than previous studies, which they said could have been due to their selection criteria.

“We encourage further study before concluding that the psychology of fresh starts does not apply to medication adherence,” the researchers wrote. “Because fresh-start dates motivate individuals wishing to initiate goal pursuit, our timing- and framing-based treatments may increase the effectiveness of reminders when reminders involve goal-setting activities. Additionally, there is often a delay between a target fresh-start date and the date when treatment-condition reminders were actually received; in the New Year conditions, reminders often arrived in late January. Reminders received immediately after the target date could be more effective. Further investigation into alternative ways to leverage fresh starts and compel patients to attend to public health messaging would be valuable.”