Background: Adherence is a critical component to achieving successful outcomes in chronic illnesses like cSLE. Previous studies have indicated worse outcomes among non-adherent patients. Poor adherence to routine clinic visits is a significant problem in the management of SLE. Regular clinic appointments provide ideal opportunities for early intervention to avoid disease flares and maximize therapeutic regimens.
Purpose: Our aim was to improve visit adherence using cellular text messaging reminders (CTMR) and assess its impact on disease outcomes in cSLE.
Methods: An individualized CTMR was sent 7, 3, and 1 day(s) prior to each scheduled clinic appointment. Scheduling of subsequent follow-up clinic visits was also aided by CTMR as needed. Overall visit adherence was monitored prospectively over 8 months and compared to the historic visit attendance for each participant over the preceding 30 months (following standard of care [SOC]). Acceptable visit adherence was defined as attendance of >80% of the recommended visits as per the managing physician. Disease outcomes (SLEDAI- SLE Disease Activity Index and number of unplanned emergency room visits and hospitalizations) during the 8-month CTMR intervention period were compared to each subject’s previous information during the SOC time period prior to the use of CTMR.
Results: 70 cSLE subjects (ages 13-28 years old, 93% female, 51% African American) agreed to participate by providing cell phone numbers and cellular service providers. Of the 66 participants with complete data, 64% (42/66) had poor visit adherence (<80%) during the SOC time period. Overall, the proportion of subjects with good attendance improved from 36% to 56% (p=0.04). With CTMR, 52% (22/42) of non-adherent subjects had newly acceptable visit attendance (> 80%). In addition to positive attendance trends, rates of visit no-shows significantly decreased (p=0.004), while self-requested visit cancellations increased (p=0.0001). No important changes in disease outcomes were observed.
Conclusion: Advances in communication technology are widely utilized by teens and young adults with cSLE. CTMR can be used as a means of improving clinic visit adherence. Important changes in disease outcomes may require longer-term CTMR intervention periods. Further studies of CTMR for both visit and medication adherence may prove highly effective and ultimately translate into improved health care utilization and better disease control in cSLE.