Study: Text Reminders Increase Prescription Fulfillment Rates in Patients With Congestive Heart Failure

A new study published in PLOS Digital Health found that interactions with short message service (SMS) text reminders among patients with congestive heart failure (CHF) increased prescription fulfillment rates and reduced hospital readmission rates. The data suggest that the use of novel technologic strategies could contribute to more stringent medication adherence in vulnerable patient populations.¹

The investigators, led by Ben Long, MD, director of Hospital Medicine at Magnolia Regional Health Center, and Weston Blakeslee, PhD, vice president of Clinical Intelligence at DrFirst, conducted the study at a rural hospital in the southeastern United States. Following the submission of an e-prescription, patients with a primary diagnosis of CHF were sent a text message. The message was interactive and included a patient-tailored link that provides information for the prescription destination, written and video educational content, and insurance assistance when applicable.^1,2

Overall, the effect of clicking SMS nudges on the filling of all medications across all groups was a striking 19% increase in fulfillment (odds ratio [OR], 1.19; 95% CI, 1.15–1.24; P < .001).¹

Prescription Fulfillment Improvements Observed Across Subgroups, While Hospital Readmission Rates Declined

Three categories were formed based on patient demographic criteria. “Non-readmitted” patients had an initial inpatient visit with a primary diagnosis of CHF and no subsequent emergency department (ED) visits; “return visit to ED” patients returned to the ED within 30 days of their primary diagnosis but were stabilized and discharged; and “readmitted to inpatient (IP)” patients returned to the ED and were deemed to require a repeat inpatient stay.¹

For non-readmitted patients, clicking the SMS nudge increased medication fill rates by 15% (OR, 1.15; 95% CI, 1.1–1.2, P < .001). For patients with a return visit to the ED, there was no significant difference in the odds of filling a medication; however, patients readmitted to IP saw the largest increase, with a 52% increase in the odds of filling a medication following clicking the SMS nudge (OR, 1.52; 95% CI, 1.37–1.69, P < .001).¹

Long, Blakeslee, and their team also investigated a potentially correlative effect on the odds of hospital readmission in the population. When controlled for age and maintenance drug status at the medication level, there was a 6% reduction in the odds of a readmission if a patient interacted with the SMS nudges (OR, 0.94; 95% CI, 0.9–0.99, P = .009).¹

“Having the ability to engage with text messages and smartphone utilization is far from universal,” Long explained in an interview with Pharmacy Times^®. “But the prevalence of personal devices today and this notion of your care coming to you clearly has a place in advancing this idea that promoting better access to care leads to better outcomes and experiences.”²

How Text Nudges Overcome Barriers to Access

Blakeslee spoke to the main barrier leading to gaps in medication adherence that they sought to address in the study: forgetfulness. He noted that prescriptions can oftentimes get held up in the prescriber’s workflow, thus preventing more immediate notification of prescription fulfillment. “By addressing this, you know for a fact that your prescriber has actually sent the prescription to the pharmacy, and you get that mental cue to say, ‘Okay, great, I can go to my pharmacy,’” Blakeslee explained.²

Long addressed the many barriers to medication adherence that he sees in his daily interactions with patients, including questions surrounding proper dose timing, financial considerations, and concerns over possible adverse effects. Polypharmacy is also a prevalent issue, according to Long; patients are accustomed to a “single pill for every ill,” but for more complex treatment methods for diseases like CHF that may require multiple medications, patients “sometimes just don’t want to do it.”²

The experts said that the text nudges employed in the study can make health care for CHF “feel less episodic” while promoting “better communication and equity.” When these digital interventions are effectively integrated into pharmacy workflows, it allows for automated, seamless, and clinically effective reminders that promote adherence for the patient and improve outcomes across the board.²

“Getting to these vulnerable patients avoids a snowball effect that can result in avoidable outcomes for all stakeholders, especially the patient,” Blakeslee explained. “Once you refine digital interventions with vulnerable populations, all patients will benefit down the road.”²

REFERENCES

1. Long B, Davis B, McPheters R, Blakeslee WW, et al. Interaction with SMS text-reminders correlate with improved medication adherence and readmission rates for congestive heart failure patients: A retrospective cohort study. PLOS Digit Health. 2025;4(12):e0001157. doi:10.1371/journal.pdig.0001157

2. Long B, Blakeslee W, Halpern L. Experts: Study shows text messaging boosts prescription fulfillment. Pharmacy Times. January 15, 2026. Accessed January 16, 2026. https://www.pharmacytimes.com/view/experts-study-shows-text-messaging-boosts-prescription-fulfillment