Using Text Messages To Remind Kids About Meds
Posted on: Tuesday, 13 May 2008, 00:05 CDT
Doctors in Cincinnati have started using text messages to remind teenage patients with chronic conditions such as asthma, diabetes or kidney disease to take their medicine.
The approach is meant to tackle the difficult problem of adolescents who often either forget or simply skip taking their medication or other therapy, often out of rebellion, denial or the fear of feeling different from their healthier friends. It’s something particularly problematic for teens, as some illnesses can simmer without obvious symptoms until it’s too late.
"It's a time of so much change in these kids' lives," Dr. Marva Moxey-Mims at the National Institutes of Health (NIH) told the Associated Press.
"It's very difficult when you've got a life-threatening illness to say, 'Let them make their mistakes.'"
Data is sparse on precisely how many young adults with chronic illnesses neglect to adhere to therapy, but the statistics that do exist are disturbing. The NIH's National Institute of Diabetes and Digestive and Kidney Diseases are bringing specialists together in September to discuss and debate the issue.
Previous studies suggest only half of adolescents properly follow treatment,” Dr. Dennis Drotar of Cincinnati Children's Hospital told the AP.
Worse yet, the more medications required or the more bothersome the side effects, the worse the kids adhere. Some medications, such as steroids that can cause weight gain, are often avoided in appearance-conscious teens.
The record is particularly concerning for those with asthma, with some research showing as few as 30 percent of teenagers correctly take medication to prevent attacks. And adolescent kidney transplant recipients have the worst long-term outcomes of any age group, Moxey-Mims said.
Even when parents are vigilant, "kids are cunning," said Drotar.
"Parents are in a bind because there's pushback."
Drotar recalled using a monitor to detect whether cystic fibrosis patients performed a chest-thumping therapy to clear their lungs. In the case of one adolescent patient, Drotar observed strange readings: the teen had strapped the monitor onto his dog.
Kabrina Moton of Cincinnati,16, knows if she hasn’t taken her daily asthma medication she'll start wheezing and need her inhaler when she plays basketball.
Still, she confessed that "one time I went a whole month without taking it."
"It's just work and school and being in and out of the house all the time. ... When I would think about it, I wasn't around it or I was out and I wouldn't remember later on," she told the AP.
This is where doctors believe using reminder text messages may help.
Asthma specialist Dr. Maria Britto of Cincinnati Children's Hospital noticed that even when she's talking to adolescent patients sitting on the clinic exam table, the teens would keep texting on their cell phones.
"You have to get in their face a little," she says with a smile.
But it’s something that created the idea for a study to determine if a daily text message reminder would improve kids' asthma control, something doctors hoped would prevent full-blown attacks, improve school attendance and decrease doctor and emergency-room visits. Britto notes that kids as young as 12 from a variety of backgrounds carry the phones into her clinic.
A trial started recently, with a full study planned for later this year. Participants choose the time of day they wish to receive their reminder, and a clinic volunteer types out the messages, but with the words spelled out in full instead of in the standard text message lingo typically used by kids.
Moton, who gets her reminder text message every evening at 7 o’clock, says so far she hasn't missed a single dose of her medication.
"It always says, 'Have a nice day,'" she told the AP.
"It makes me feel good about it."
Doctors hope that if the simple reminders work for asthma, they may for other conditions as well.
"We have the science" backing treatments, Britto said.
"We just can't figure out how to get the right drugs into the right kids' bodies."
However, proper adherence to medication is only one part of a multifaceted problem. Families must first appreciate the importance of following treatment even when children feel fine, and parent-adolescent relationships also play a significant role.
"Kids are thinking short-term and not long-term complications. If they're feeling better for the moment, there's a tendency to keep testing the limit," says Drotar, who tracked teens whose leukemia was in remission, and was astonished to find 30 percent had no evidence in their blood of the follow-up medicines that help sustain the remission.
Drotar's team is now examining various techniques with those leukemia survivors, such as discussions between parents and teens about treatment barriers, and brainstorming sessions to find solutions without the nagging and conflict that often occurs.
Another approach is peer pressure, where older teens with these conditions can both empathize and share experiences of the challenges associated with the illness and with treatment.
One NIH-funded study, conducted by researchers in Cincinnati, the University of Miami and the Nemours Clinic in Wilmington, Del., is tracking 9- to 11-year-olds and their families for three years, to determine what predicts a drop-off in the control of Type 1 diabetes during adolescence. Not surprisingly, kids with stable families and positive parent relationships fare better, Drotar says.
Source: redOrbit Staff & Wire Reports
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